Thursday, August 8, 2013

September 9th-12th 2013. Washington, DC. US Paralympic Introductory Sport Camp for Disabled Service Members and Veterans


Sport Clinics Include: Boccia, Archery, Cycling & Rowing

If interested please contact the POC below. Registration closes August 26, 2013

Participation in the camp is free




Contact information
Leslie Winckler, leslie.winckler@usoc.org or

U.S. Olympic Committee, Paralympic Sport Outreach & Development
1 Olympic Plaza, Colorado Springs, CO 80909




**Registration Deadline: August 26, 2013**

2013 U.S. Paralympics Introductory Camp Registration Form

September 9-12, 2013 @  Landover, Maryland
Prince Georges Learning & Sports Complex
Travel Date: September 9th & 12th
* required fields
Please submit this form via e-mail or fax to Leslie Winckler.  
 Leslie.Winckler@usoc.org
or 719-866-2029 (f)
Name, as appears on ID
*Last:
*First:  
Middle:  
Nickname:
       Male          Female
*DOB:
*Last 4 digits of SSN:

Address:
P.O. Box:
City:
State:
ZIP Code:
*Primary Email:
*Mobile Phone:
Secondary Phone:
Disability (circle):           A/K Amputee       B/K Amputee       Traumatic Brain Injury        
Spinal Cord Injury (region?)            A/E Amputation                     B/E Amputation
Wheelchair User?        Y         N                                             Do you use a power chair?            Y       N   
    
Do you need assistance when transferring?       Y         N         Do you require a shower chair?      Y       N
*Do you require travel assistance or care giver?                                 Y        N
Departure Airport (home airport):                       
Return Airport (if different from departure airport):

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