| Contact TWSA |
| *** Please use correct upper and lower casing *** |
| IMPORTANT: TWSA REGISTRATION WILL NOT BE AVAILABLE UNTIL MARCH 2010 |
| First Name:* | |
| Last Name:* | |
| Birth Date:* | (mm/dd/yyyy) |
| Email:* | |
| Company Name: | |
| Job Title: | |
| Address Line 1:* | |
| Address Line 2: | |
| City:* | |
| State:* | |
| ZIP/Postal Code:* | |
| Cell Phone:* | |
| Phone:* | |
| I would like to participate in TWSA:* | Volunteer on land
Volunteer in water
I am a surfer with a disability
Film/Video
I have equipment to loan (list below)
|
| If you selected to volunteer in the water, please indicate your preference:* | |
| Have you participated in a TWSA event in the past?:* | |
| Have you ever been a TWSA team leader?:* | |
| If you would like to participate as a surfer with a disability - please describe your experience level and special needs: | |
| I would like to make a product donation for TWSA: | Wetsuit
Neoprene Life Jacket
Soft Top Surfboard
Beach Wheelchair
Items for prize giveaways
Other (Please describe below)
|
| Do you have a Spinal Cord Injury?:* | Yes
No
I know someone who does
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| Give us some details to the above answer: | |
| Suggestion for future TWSA event location: | |
| What specific skill set - knowledge or perhaps personal connections do you have that may be used to further our cause?: | |
| If requested by LRO, I agree to complete a feedback survey after the completion of the event:* |
Yes, of course!
No
|
| How did you first hear about LRO?:* | |
Create Username and Password
|
| Username:* | |
| Password:* | |
| Verify password:* | |
| Security Question:* | |
| Security Answer:* | |
