Luke Perry Volleyball Academy Youth Development Holiday Camp with Tom Heptinstall Australian Volleyroo, Tom Heptinstall, is teaming up with the Luke Perry Volleyball Academy to deliver a Youth Development Holiday Camp this Thursday, Friday and Saturday at Aquinas College. Athlete InformationName* First Last Gender*Please SelectFemaleMaleWhat is your age?*Date of Birth* DD slash MM slash YYYY School*Email* Enter Email Confirm Email Mobile*Address* Street Address City ZIP / Postal Code Local Government*What Local Government Area do you reside in? City of Canning City of Melville City of South Perth Town of Victoria Park Do you currently play WAVJL or WAVL for a club?* Yes No If yes, which Club?*Volleyball WA Membership Status*What is your current Volleyball WA Membership Status? * Please note all athletes that wish to be involved in this program must have a Volleyball WA Gold or Platinum Membership. Platinum Gold Silver No Membership Volleyball WA Membership Number*Please enter your Volleyball WA Platinum or Gold Membership Number (Contact Code) in the field below. This membership provides athletes with Personal Accident Insurance. Your membership number is the Contact Code that can be found on your profile on the VWA Fortix website. > FORTIX LINK Your VWA membership status must be upgraded in order to register for this program. Please click on the link below to sign in or register on VWA’s Fortix system and purchase a Gold or Platinum Membership. > FORTIX LINK Once you have your membership number please return to this form to register.Emergency Contact InformationEmergency Contact Name*Emergency Contact Relationship*Emergency Contact Email* Emergency Contact Mobile*Association RequirementsReds Membership Agreement*I have read and agree to comply with the Reds Membership Agreement. Yes Policies*I agree to comply with all Association and Club policies. Yes Associate Member*I understand that by completing this membership I will become an Associate Member of the Perth Reds Volleyball Association and the Reds Volleyball Club. Yes Program InformationPlease choose number of days*1 session2 sessions3 sessionsPlease select the date of the session you will be attending*Thursday 11 AprilFriday 12 AprilSaturday 13 AprilPlease select the days you will be attending* Thursday 11 April Friday 12 April Saturday 13 April 2024 LPVA Heptinstall Camp - 1 day*Credit Card Fees Apply Price: 2024 LPVA Heptinstall Camp - 2 days*Credit Card Fees Apply Price: 2024 LPVA Heptinstall Camp - 3 days*Credit Card Fees Apply Price: Credit Card*Card Details Cardholder Name