Scorchers Basketball - Member Registration

Fields marked with * are mandatory.

Name *

Registration Number *

Registration Code

Registration Paid *

Registration Expires *

Postal Address *

Suburb/Town/City *

State *

Post Code *

Home

Mobile

Fax

Work

Email

Date of Birth *

Occupation

Gender

Primary Registration *

Yes
No

Secondary Affiliation *

Yes
No

Involvement *

Junior - Under 18
Senior - Over 18
Mini - Under 10 not playing in competition

Player/Referee *

Player
Referee

Other Involvement

Team Name

Club Name

Age Group

“I hearby acknowledge that if I participate in any competition...”

I agree to all Conditions *