Speak out and be counted!

Attention all people with disabilities, friends, family members and supporters.  America’s Athletes wants to show the world just how many people with disabilities are currently participating in sports, recreation, leisure, health and fitness activities.  The ability to effectively and accurately identify the number of athletes with disabilities and the number of other involved individuals (family, friends and supporters) will help to support and justify positive and beneficial decisions on funding and resources for disability sports. 

In order to collect and provide accurate information, America’s Athletes is building a National Disability Sports Registry listing Athletes, their Friends, Family and Supporters.  Please add your name and help us demonstrate how many people participate in and support disability sports and recreation! 

Please complete this form and mail it to: or Email your registration to:

           America’s Athletes with Disabilities

           2813 Spindle Lane

           Bowie, MD 20715-2136 

           Phone: (301) 464-3776

           Fax:     (301) 464-3776

           Email:  drwmson@aol.com

          

Name:    ___________________________________________________________

Address: __________________________________________________________

              __________________________________________________________

City:______________________________________________________________

State:_____________________________________________________________

Zip Code: __________________________________________________________

Phone Number/Fax: _________________________________________________ 

Email:_____________________________________________________________ 

Please circle your level of participation: 

Athlete (current & former) | Recreation Only | Fitness and Well Being | Other 

If you are not an athlete or recreational participant, include, are you a family member, friend or supporter of an athlete or recreational participant?  Please circle all that apply: 

Family Member (Parent, Spouse, Sibling)  

Friend         Spectator              Community Organizer        Teacher      

Sports Writer/Media     Coach/Trainer         Student       Financial Supporter 

Please indicate primary disability category: 

Blind/vision impaired      Deaf/hard of hearing    Mobility impaired/use a wheelchair  

               Other           Amputee        Cognitively impaired    

                     Mobility impaired/do not use a wheelchair            

Your Interest:  Please indicate  sports, recreation, leisure, health and fitness activities that you have participated in the last 12 months:

______________________________________________________________

If you would also like to be referred to one of the national Disabled Sports Organizations which is recognized by the United States Olympic Committee, please indicate your choice.  

Dwarf Athletic Association of America (DAAA)       Wheelchair Sports USA (WSUSA)

National Disability Sports Alliance (NDSA)             Disabled Sports USA (DSUSA)

US Association of Blind Athletes (USABA)                Special Olympics

USA Deaf Sports Federation (USADSF)                 Other       

Please indicate your highest level of competition in the last 5 years: 

Community     Regional     State     National       World/Paralympics       Other 

Are you interested in receiving information about disability sports events or activities? 

     YES ________                NO __________

Email Address:_________________________________

 

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