WOMEN’S REGISTRATION FORM - 2017 SEASON
Registration Fee: $130.00 (Includes, Game T-shirt and basketball shorts)
Family rates do not apply to this level
Cheque is to be made out to: West Island Outdoor Basketball League or WIOBL
Please note that there will be a $35 charge for NSF cheques
Please return the completed form below, for each player, with your cheque(s) or (Cash can be dropped off at :)
West Island Outdoor Basketball League
13136 Monk Blvd. Pierrefonds, Québec, H8Z 1T6
Refund policy: All refund requests must be sent, in writing prior to the first regular season game, to the above address. Refund minus
$25.00 administration fee
NO REFUNDS WILL BE ISSUED FOR REQUESTS RECEIVED AFTER THE FIRST REGULAR SEASON GAME
Questions, need more information?
Call Steve at WIOBL: (514) 626-6044 or email [email protected] or visit us at
WWW.WIOBL.COM For all information.
I agree that I can be traded at any time for the purpose of balancing teams
Fill in and return the lower portion and keep top portion for your files:
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Registration: Women 17 and over. AGE AS OF MAY 1, 2017
Player’s name: ____________________________________________________________Height___ft___ins or _____cm
Family name
Please print clearly
First name
Address: ___________________________________________ Apt.______ Borough: (City) ___________________
Civic No.
Street name
Postal Code: _________________ E-mail (Capital letters) _________________________________________________
Tax receipts for 17 will be emailed. Please print legibly
Tel # :(_____)_______________________(_____)____________________________(______) ______________________
Home
Office
Cell
Medicare #: ________________________________________ Date of birth: ____________________________
A photocopy of the Medicare card to be included
(Day / Month/ Year )
Experience: (None)
(House League)
(Intercity)
(High School)
WIOBL
Other _____________
West Island Outdoor Basketball League Waiver
I above hereby release and discharge the West Island Outdoor Basketball League (WIOBL), its organizers and its directors and all other volunteers from
any and all future claims or demands for loss, damage or bodily injuries which may result directly or indirectly from participation in the said activity
I also agree that I can be traded at any time for the purpose of balancing teams
Signed: _______________________________________Name (please print): __________________________________
Would you like to sign up as
We need volunteers!
Team Captain:
Assistant captain:
Other: _____________
We need Referee’s; Apply for a paying job at WIOBL. Weeknights Monday or Wednesday and lower levels Friday night,
Saturdays and on rained out games, an occasional Sunday. Or if you know someone that would be interested add Please
have them contact us at (514) 626-1613 or email [email protected].
I want to Referee:
NAME: ______________________________________Phone No._______________________
Please Print
INTERNAL USE: Date received: _________________Cheque
Cash
Amount_______________
(Day / mm / Year )
Remarks: ________________________________________________________________________________________