Athlete Registration Form

Special Olympics Club wishing to Join

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Registration Type (mark one or both)

VOLUNTEER / UNIFIED PARTNER INFORMATION

First Name

Last Name

Preferred Name (If different to the above)

Date of Birth (dd/mm/yyy

Address

Telephone Home

Mobile

I prefer to be contacted by

Please tick this box if you would like to recieve Fanletter, our monthly electronic newsletter (email address required in contact details above)

Telephone Work

Email Address

Ethnicity

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Postal address:

PO Box 38344, Wellington Mail Centre, Lower Hutt 5045

Physical address:

Pelorus Trust Sports House, 93 Hutt Park Road, Seaview, Lower Hutt 5010
 

Telephone: +64 4 560 0360

Fax: +64 4 560 0040

Email: admin@specialolympics.org.nz

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