Pickleball Registration of Interest Form

1. First Name*
2. Surname*
3. Email*
4. Phone Number*

Preferred Session(s)*

Monday (Augusta): 7pm - 8:30pmMonday (Margaret River): 9:30am - 11amTuesday (Margaret River): 5:30pm - 7:00pmWednesday (Margaret River): 8:30am - 10:00am

5. Level* Please select... I’ve never played pickleball before I’ve never played pickleball before but I have a decent racquet sport background I already know how to play pickleball - my level is novice I already know how to play pickleball - my level is intermediate I already know how to play pickleball - my level is advanced
6. Age range* Please select... Under 12 12 - 17 18 - 35 36 - 59 60+
7. I agree to my contact details being provided to the facilitator of the pickeball program. I agree

   As pickleball sessions may be coorindated and organised by a community member and/or the Shire's Sport and Community Recreation team, we request your permission to forward your contact details onto the facilitator of the program.

* denotes a required field.