BASKETBALL DEVELOPMENT PROGRAM
PARTICIPANT REGISTRATION FORM
Sunday 13th Septemeber to 8th Novemeber 2009 (8 weeks):
9:00am - 10:45am
Auburn Basketball Stadium
Church Street (Wyatt Park), Lidcombe
PLAYER DETAILS (5-14 years old)
First Name:
Last Name:
Age:
Birth Date:
Gender:
Male
Female
T-shirt Size:
Address:
Suburb:
Postcode:
Home Phone:
Mobile Phone:
Email Address:
School:
MEDICAL HISTORY
Does the player suffer from any allergies and/or medical, physical or mental disability (eg, asthma, epilepsy, etc):
Yes
No
If YES, please specify including details:
PARENT CONSENT
I personally consent to the applicant registering/participating in the Buddies 4 Life Basketball Development Program 2009.
Full Name:
Relationship to Participant:
Home Phone:
Mobile:
Email Address
EMERGENCY CONTACT (if different from above)
Name:
Phone:
Where did you hear about “Buddies 4 Life” Basketball Development Program?
Chinese Newspaper
ACBA Website
Email
Flyer
Word of Mouth
Other
COST PER PARTICIPANT:
$150.00 (Incl GST)
***SPECIAL* ** JOIN WITH A BUDDY:
$135.00 p/p
Friend's Name:
To secure your place in the program, full payment is to be made via:
Cash
Cheque
Direct Deposit
Banking Details: VIBE SPORT #370 812 BSB 032 070
Please quote participant’s full name.
Email:
info@vibesport.com.au
Any queries, please phone:
Emma: 0405 168 002
Tiana: 0401 003 216