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Wheelchair Wash and Tune Registration
We are looking forward to you joining us!
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Are you a wheelchair user?
*
Yes
No
Other:
If yes, wheelchair type.
*
Power
Manual
Other:
Guest, if attending: First Name
Your answer
Guest, if attending: Last Name
Your answer
Reserve a time slot (all time slots are 1st come first serve)
*
12pm - 12:45pm
12:45pm - 1:30pm
1:30pm - 2:15pm
1st preference
2nd preference
3rd Preference
12pm - 12:45pm
12:45pm - 1:30pm
1:30pm - 2:15pm
1st preference
2nd preference
3rd Preference
How did you hear about Wheelchair Wash and Tune?
*
Facebook
Instagram
Twitter
Email
Other:
Thank you for registering. A conformation email will be sent.
A copy of your responses will be emailed to the address you provided.
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