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

Pamela Lehnert,Pamela.j.lehnert@medstar.net

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):