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Home > Walk Wheel Run Event Registration


Join us for our 2012 Walk Wheel Run around the beautiful East Perth and Burswood Park Foreshores on Sunday 18 March.

You can choose to walk, wheel or run around Burswood Park Foreshore in either a 1km or 6km circuit.

Registration Form

Registration Date: / /  

Enter your personal details - This is a secure site
Title:
First Name:
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Phone Work: Please include area code
Phone Home: Please include area code
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Comments:

Registration

I would like to register as:    Concession ($5)                   Individual ($10)   

                                         Family / Team ($20)               Number of family/team members:

                                           ( Maximum 5 members. Additional members $5.00ea )

                                           Total Cost:$


Payment Details
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Expiration Date: /20 (mm/yy)
Receipt to:

Privacy Statement
The Centre for Cerebral Palsy depends on supporters like you to fund our varied services to benefit the lives of children and adults with CP, and we thank you for your generosity. We do not sell, rent or otherwise make available any information about our supporters.

I have read and agree to the terms and conditions    
 

Other Methods of Registration

By phone
(08) 9443 0216 between 8.30am and 4.45pm weekdays.

By mail
Print the offline registration form, fill in the details and mail it to:

The Centre for Cerebral Palsy
PO Box 61
MOUNT LAWLEY WA 6929

By fax
Print the offline registration form, fill in the details and fax it to: (08) 9444 7299 (Attention: Kathy Kane).

By email
Email your contact details to rhiannon.holmes@tccp.com.au.


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106 Bradford Street, Coolbinia WA 6050 post PO Box 61, Mount Lawley WA 6929   |  e info@tccp.com.au  |  t 08 9443 0211  |  f 08 9444 7299
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