The Burke Rehabilitation Hospital Wheelchair Games App 2006 Page 3
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
NDSA ATHLETE REGISTRATION FORM
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)
Team Name (if applicable): _____________________________ Independent
T-Shirt size:
S
M
L
XL
XXL
Child:
M
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A. TRACK/FIELD EVENTS: Indicate your choice by circling/checking those
events you are eligible to compete in (those events not shaded).
Class 1
Class 2U
Class 2L
Class 3
Class 4
Event
A B C D A B C D A B C D A B C D A B
C
D
20 Meter Dash
40 Meter Dash
60 Meter Dash
60 Meter Weave
100 Meter
200 Meter
400 Meter
800 Meter
1500 Meter
High Toss
Soft Shot
Precision Throw
Soft Discus
Softball Throw
Club Throw
Shotput
2kg 2kg 2kg 2kg
2kg 3kg 3kg
2kg
2kg 3kg
3kg
Discus
Javelin
NDSA FORM
