Krazy Kosci Klimb : Register your interest

If you’ve heard about this amazing event and you are keen to join us, we have several options for people wanting to take part in the Krazy Kosci Klimb. Whether you are a person living with a disability and would like to be one of this year’s Lead Team Participants, a Corporate company interested in sponsoring a team, or a Cerebral Palsy Alliance employee wanting to be a team leader we’d love to hear from you.

To be considered as a Lead Participant you are required to be aged between 12 and 20 years old. Participants must be over the age of 12 on the date of the event and have parental or guardian permission. Lead Participant applications close on Thursday 15 August 2019.

I'm registering my interest for: *

First name *

Last name *

Date of birth *

Address *

Suburb *

State *

Postcode *

Phone number *

Email *

What's the best way for us to contact you? *

Tell us a little bit about yourself

How did you hear about The Krazy Kosci Klimb? *

What's your motivation to take on the challenge? *

For Lead Team participants only - ( to be considered answer all questions)

Are you a customer of Cerebral Palsy Alliance?

If so - what CPA centre do you attend?

Who is your main contact at Cerebral Palsy Alliance?

What do you identify as your primary disability

Other disability, please specify

Do you rely on a mobility aid?

If so, please specify your mobility aid

Fundraising is a component of the Krazy Kosci Klimb. What are some of your fundraising ideas for your team? *