Register your interest in our High Performance program

Thank you for your interest in the Healthy Mates Physiotherapy and High Performance Centre at the Bendigo Stadium.

To receive more information about High Performance, please complete the form below.

Name*
First Last
Address*
Postcode
Date of birth*

Day
Month
Year
Are you less than 18 years old?*
- Yes
- No

Mobile Phone
e.g. 0422 333 444
Email*

e.g. john@email.com

Your contact information
Email

e.g. john@email.com If you don't have an email address, you can leave this blank.
Mobile Phone
e.g. 0422 333 444 If you don't have a mobile phone, you can leave this blank.
Parental contact information
We need the contact information of a parent or guardian for anyone under 18 years old.
Email*

e.g. parent@email.com
Mobile Phone
e.g. 0422 333 444

What is your sporting interest?

e.g. Basketball, Football
Are you currently a student?*
- Yes
- No
What is the name of the school or university you attend?*
I am interested in:
- High Performance
- Physiotherapy
Please select all options that apply

How did you hear about us?

e.g. Google search, Radio ad, Social media
Would you like to get regular email updates from Healthy Mates?
Yes, sign me up to the newsletter!
We collect your data in accordance with our Privacy Policy and store it securely. We will not spam you.
Email
This field is for validation purposes and should be left unchanged.

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