ADULT WOMEN’S REGISTRATION FORM
2012 SEASON
Registration: Fee: $120.00 (Includes, Game T-shirt and basketball shorts)
Special and Family rates do not apply at the adult level
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
ébec, H8Z 1T6
13136 Monk Blvd. Pierrefonds, Qu
Qué
Cheque is to be made out to: West Island Outdoor Basketball League or WIOBL
Please note that there will be a $25 charge for NSF cheques
Refund policy: All refund requests must be sent, in writing prior to the first regular season game, to the above
address. A refund of 100% will be reimbursed
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 18 and over. AGE AS OF MAY 1, 2012
Player’s name: ___________________________________________________________________ Height______
Family name
Please print clearly
First name
Ft. – Ins.
Address: ______________________________________Apt.______ Borough: (City) ______________________________
Postal Code: _______________________ E-mail (Capital letters)
____________________________________________
Tel #:: (_____)_______________________(_____)____________________________(______)______________________
Home
Office
Cell
Medicare #: ________________________________________
Date of birth: ____________________________
A photocopy of the Medicare card to be included
Experience: (None)
(House League)
Day
(Intercity) _
(High School)
Month
WIOBL
Year
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): _________________________________
We need volunteers!
Would you like to sign up as
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 number: _________ Cash__________ Amount_________