EmailMe Form - 2013 QLD Paragliding Championships Registration

Name *
First Last
Phone *
Your Email Address *
I Have Signed the Competition Waiver?
(Please Bring It) *
Yes
No
Which Rounds Do You Wish To Participatre In
May 4/5 - Toowoomba
June 22/23 Canungra
August 10/11 Canungra
September 14/15 Killarney
October ??/?? Canunga Cup
Team Contact
Team Contact Name *
First Last
(name of flying buddy; if we cant contact you)
Mobile Phone *
Emergency Contact
In the event of an emergency who should we contact? Like your Mother
Emergency Contact Name *
First Last
Emergency Phone *
Image Verification

Please enter the text from the image:
[Refresh Image] [What's This?]