REGISTRATION
Cruisers Sports for the Physically Disabled    
 

Address:


City: Prov/State:
Potal/ZIP Code: Country:

Cell: Home: e-mail (MANDATORY):

Emergency Contact:
Please try to list someone local if you are visiting from a distance
Name: Phone:

Class & Division:
Class: Junior Open
Do you need to be classified? please select no yes - CP yes - Wheelchair/amputee yes - blind (contact PSO for forms) yes - other
I require IPC classification
IPC License number:
AO Member number:

Name of guide (if applicable):

Note: International classification will be on Friday May 11th, 2012. Email to follow for classification schedule for those needing to be classified. Provincial classifications will take place Saturday at 8 am.

Events:
You MUST provide a seed time for each track event entered (please enter in form of 00:00.00 {mm:ss.ms}).

Paid by club Cheque Wire Transfer PayPal
I would like a reciept

Please forward payment to:
Cruisers Sports for the Physically Disabled
c\o Brenda Hall
772 Golden Farmer Way
Mississauga, ON  L5W 1A7

NO REGISTRATIONS WILL BE ACCEPTED DAY OF EVENT.
All registration forms are due April 28th, 2012, at a cost of $35 for Ontario athletes, or $45 for athletes from out of province/country. All costs are in CANADIAN funds, and payment will be accepted in advance.
Any application received after April 28, 2012 will be returned.
NO LATE REGISTRATIONS WILL BE ACCEPTED!

You WILL recieve an email confirming your registration, usually within 24 hours.

Please check your entries for errors before submitting!