Membership Registration Form

MEMBERSHIP REGISTRATION FORM

REGISTRATION INFORMATION

Name:		Phone #:
Address:
City:	State:	Zip Code:
E-mail Address:
Membership Length:

Fill out for Family Membership	First & Last Name
Family Member 1
Family Member 2
Family Member 3
Family Member 4
Family Member 5
Family Member 6

AUTHORIZATION & PAYMENT

The undersigned fully understands the rules and risks associated with playing sports/activities and agrees to play at their own risk. Basketball America, its employees or its sponsors are not liable for any injury or loss associated with playing in this league. All players will behave with good sportsmanship. Any swearing, fighting, arguing etc. will result in ejection from premises. There is a no refund policy once registration is accepted.

If paying in person or faxing, you must sign printed form in the Parent's Name box. By electronically submitting, it is understood that you agree to all of the terms above.

You will be charged based on your chosen package. We will notify you when your membership is active. Please call us if we have not responded within 24 hours of your registration.

OFFICE USE ONLY:
PAID: ____________	DATE: ____________
TYPE: ____________	INIT: _____________

Name on Card:

Method of Payment:	C.V.V. Code on Back: (Help?)
Credit Card#:	Exp. Date:/

Please print form, before submitting, for your records, or print completed form and return/fax (248-693-7186) to Basketball America.

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