CPSARA Membership
NB: Please complete this form in full. On pressing "Process Membership" you will be taken to a secure payment server where you can pay using your Credit Card or with your PayPal Account. Your Membership only becomes valid on completion of the payment process. Fields marked with a * must be completed.
First Name:
* *
Last Name:
*
Address:
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Suburb:
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State:
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Postcode:
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Email:
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Home Ph :
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Mobile :
Work Ph:
    
Fax:
 
Please select one
Please select one
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New Member
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Athlete
Renew Membership
Non-Athlete ($10.00)
Athlete Information
Date Of Birth:
*
Type Of Disability:
*
Do you have a Medical Diagnosis Of Cerebral Palsy: * Yes No

Have you been officially classified in any of the following?
Please complete relative sectionbelow if you anwsered "Yes" to the above question.

Swimming:
Yes No Class:
Cycling:
Yes No Class:
Athletics:
Yes No Class:
Football:
Yes No Class:
Other Sport & Recreational Activities You Are Interested In.

I HEREBY AGREE TO ABIDE BY THE RULES OF THE ASSOCIATION AND UNDERSTAND AND AGREE I MAY BE APPROACHED BY & RECLASSIFIED BY AUTHORIZED PERSONS AT ANY EVENT I ATTEND.

I HEREBY * TO THE ASSOCIATION USING MY PROFILE AND IMAGES TO PROMOTE THE ASSOCIATION.

Cost: $
Includes Handling
Fee $1.00
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