Membership Application Form

Press Releases

2012/2013 Season Launch ... 10 October, 2012
Let's Play ... 01 September, 2012
West Tigers Support Our Stars ... 01 March, 2012
Mark Riddell To Attend Grand Final ... 18 February, 2012
Australian Representative Honoured ... 14 February, 2012
Former Administrator To Attend GF... 14 February, 2012
GRAND FINAL NSWWRL 2012... 10 February, 2012
Development Camp - Opening Ceremony... 26 November, 2011
Mathew Head named Ambassador... 21 October, 2011
The New Panthers... 14 October, 2011
Season begins for Wheel Heroes ... October 8, 2011
Season 2011/2012 - Register Now!... August 17, 2011
In a League of Their Own... October 5, 2010
The Wheel Heroes of Rugby League... September 24, 2010
Keating & Robinson Help Launch WRL... 14 December, 2009
Eels back League on Wheels... 14 December, 2009
Grand Final Photo Gallery... December 11, 2008

Membership

Written by Paul Quinn

Friday, 12 August 2011 01:39

Please complete the form below to lodge your membership application. Once you have completed the form, you will be redirected to the payment information page.

Applicant Information

Name: *

Date of Birth: *

Phone: *

Mobile:

Current Address: *

City: *

State: *

Postcode: *

Email: *

Would you like to try out for
the national team? *

Employment Information

Current Employer:

Phone:

Membership Type

Type: *

General Agreement:

General Agreement

Please click on the links below to download the Wheelchair Rugby League Australia Code of Conduct & Constitution. When you have read the files, if you wish to proceed with your application please click the tick box below to state your agreement with the terms and conditions outlined in these documents.

In agreeing to these terms and conditions, you are agreeing to abide by the Code of Conduct and Constitution governing the Wheelchair Rugby League Australia organisation unconditionally.

Code of Conduct [click here for PDF]
Constitution [click here for PDF]

Please Tick to Accept: *

Disability Information:

Disability Type:

Wheel Chair: *

Membership Agreement:

Terms and Conditions of Membership Agreement

I wish to apply for membership and understand by doing so I agree to be bound by the rules and policies set by Wheelchair Rugby League Australia Inc. I approve the use of my (my child's) name and image for marketing purposes and consent to the registering on the ARL National Database.

NOTE: The acceptance or denial of your application for membership is at the sole discretion of Wheelchair Rugby League Australia Inc.

Please Tick to Accept: *

Payment Details:

Mode: *

Donation Amount *

Pay Now:

Verification:

Last Updated on Friday, 09 September 2011 05:55