The Burke Rehabilitation Hospital Wheelchair Games App 2006 (Page 2)

2006 Burke Wheelchair Games

Sponsored by The Burke Rehabilitation Hospital

Co-Sponsored by the Tri-State Wheelchair Athletic Association

and The National Disabled Sports Alliance

Saturday, September 30, 2006

WHEELCHAIR SPORTS, USA

ATHLETE REGISTRATION FORM

(Registration Deadline: Sept. 20, 2006)

Last Name: _______________________ First Name: __________________ Pre-Registration No: ______

Address: ____________________________ City: ___________________ State:___ Zip Code: ________

Home Phone: _______________________

Work Phone: __________________

Email Address: _________________________ WSUSA ID No.: _____________

Date of Birth ___________

Age (as of 1/1/2006)*:___

___ Male

___ Female

Division:

Future (Age 6 and under)

A (Ages 7 9)

B (Ages 10 12)

C (Ages 13 15)

D (Ages 16-18)

E (Ages 19-21)

Adult (Ages 22 39)

Masters (Age 40+)

Team Name (if applicable): _____________________________

Independent

T-Shirt size:

XXL

Child:

A. TRACK/FIELD (FIELD:ENTER A MAXIMUM OF THREE EVENTS)
************************************************************************

TRACK CLASSIFICATION: (T51 T54) _____ TABLE TENNIS CLASS (TT1TT8)______
FIELD (F51 F59)_____ IF CLASSIFICATION DIFFERS PER EVENT, PLEASE LIST

FUTURES DIVISION

DIVISION A

DIVISION B

CLUB (51)

SOFTBALL

SOFTBALL (51)

TURBO JAVELIN(52-59)

SHOTPUT (52-59)

DISCUS

SHOTPUT (52-59)

40 METERS

TURBO JAVELIN(52-59)

JAVELIN (52-59)

60 METERS

60 METERS(5I,52)

100 METERS

400 METERS

SLALOM

800 METERS

TABLE TENNIS

1500 METER(53,54)

SLALOM

TABLE TENNIS

DIVISION C

DIVISIONS D/E

ADULT/MASTERS

CLUB (51)

SOFTBALL (51)

SHOTPUT (52-59)

SHOTPUT

DISCUS

JAVELIN (F2-F9)

JAVELIN (52-59)

60 METERS (51,52)

60 METERS (5I, 52)

100 METERS

400 METERS

800 METERS

1500 METERS

SLALOM

TABLE TENNIS

The Burke Rehabilitation Hospital - Wheelchair Games App 2006 (Page 2)