PORT LINCOLN 'GAMEREADY' HOLIDAY CLINIC
Registration form
Personal Information
Parent/Guardian
Name
*
First Name
Last Name
Email
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: 0000 000 000.
RAA Member Number for 10% off! (if applicable)
Player Information
Age Group
*
10 - 15 Years Old - Monday, July 6th ONLY (9.30am - 2.00pm)
10 - 15 Years Old - Tuesday, July 7th ONLY (9.30am - 2.00pm)
10 - 15 Years Old - Both Days (9.30am - 2.00pm)
Player Details
*
First Name
Last Name
DOB
Do you give consent for the above player to have their photo taken across the GAMEREADY clinic? (will be used for social media advertising purposes)
*
Yes
No
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
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GAMEREADY HOLIDAY CLINIC
Single Day
$75.00 AUD
$
75.00
AUD
GAMEREADY HOLIDAY CLINIC
Multiple Days
$150.00 AUD
$
150.00
AUD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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