EAST PERTH DISTRICT BASKETBALL ASSOCIATION (Inc.) Membership Registration Form MEMBER DETAILS Family Name: First Names Date of Birth: Team: Address: No. Street: Suburb: Home Ph: Work Ph: Email: Birth Certificate Number: Emergency Name and Contact No: P/Code: Mobile: PARENT / GUARDIAN DETAILS Parent/Guardian Name: Parent/Guardian Address: Home Ph: Email : Work Ph: Mobile: GENERAL DETAILS Membership valid to: 30/09/2016 Bedford Basketball Club Membership Fee of ... $135/Season Fees must be paid by Direct Deposit to: Bedford Districts Youth Club Bank … CBA BSB / Account … 066142 / 00901442 (please quote Bball and the players surname i.e. “BballSmith“and provide a Payment Receipt to your Team Manager) Member Signature: Date: / / My child / ward has permission to compete in the East Perth District Junior Basketball competition, representing Bedford Basketball Club. I understand that all fees are payable by the third game of the season and unless all fees have been paid, or arrangements made, my child / ward will be treated as unfinancial and may not be allowed to participate. Once fees are paid, they will only be refunded in exceptional circumstances. Parent / Guardian Signature: Date: / / WE NEED YOUR HELP Volunteers needed. The Bedford Basketball Club is an entirely volunteer based and led organisation. I am interested in participating as a: Sponsor Coach Assistant Coach Team Manager Scorer