EDSA Application Form
First Name (Required)
Last Name (Required)
Date of Birth (Required)
Gender
Male
Female
Other
Prefer not to say
Customer Number (If Known)
Address Line 1 (Required)
Address Line 2
City (Required)
County (Required)
Post Code (Required)
Email Address (Required)
Preferred Telephone Number (Required)
Would you like to enter an additional phone number? (Required)
Yes
No
Additional telephone Number
Addtional Phone Number Type (Required)
Addtional Conatct number of me
Friend
Family
Companion
Contact Name (Required
)
Disability Status
Please pick all relevant answers
(You do not need to be disabled to Join EDSA) (Required)
Neurodevelopment - Learning disability, ADHD, Autism
Blind/visual impairment
Deaf/hearing impairment
Chronic illness/long standing health condition - Cancer, Heart Disease, HIV, Fibromyalgia
Mental Health condition eg. Depression/Schizophrenia/Anxiety disorder/PTSD
Ambulant Disability - Physical impairment requiring use of walking aids
Personal Assistant / Companion
No Disability
Rather Not Say
Disability Not Listed Above (Please Indicate below)
Please Indicate your Disability that is not listed above
Name of disabled individual who you care for.
Wheelchair user (Required)
Yes
No
How do you follow Everton - Please pick all relevant answers (Required)
Hospitality Member
Season Ticket Holder
Home Match Attendee
Away Match Attendee
Official Member
Not Currently attending matches but previously one of the above categories
Shareholder
General Fan of the Club
Reasons for joining EDSA
Please pick all relevant answers
(Required)
To give feedback to Everton on the disabled supporter experience
To socialise/make friends with fellow supporters
To get information regarding EDSA events
Other (Please indicate below)
Please Indicate the other reason(s) you would like to join EDSA
About me (Please use this section to inform EDSA more about you eg. Hobbies and interests
Communication Consent (Required)
Other than processing your Application EDSA would like to contact you, would you like to receive communications
Yes
No
Once you Submit your details please scroll up to the top of the page.
Contact Information