2021/22 Ordinary Membership Application

Application for 2021/22 Ordinary Membership

Form must be completed to be a voting member of the association in 2021/22 - with expiry on 30 June 2022.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
What is your interest in the Cockburn Basketball Association and reason for applying for membership? *
Type of Membership *

New Member Renewal
CBA Constitution - Verified October 2020.
APPLICATION FEE - $22 (GST Inclusive) payable with application. This fee is non-refundable.

PAYMENT BY DIRECT DEBIT - Please send confirmation of payment to address below and label as 'FirstNameLastNameOrdinaryMember'.

Cockburn Basketball Association

BSB 306 086

Acc 4621117

NO MEMBERSHIP APPROVALS WILL BE VERIFIED WITHOUT PAYMENT BEING RECEIVED FIRST.

As per the CBA constitution, CBA applications require endorsement from an existing ordinary member. If you are unsure who an existing ordinary or life member is, please contact tyrone@cougarfamily.com who can advise you on this.
Ordinary Membership Applicant's Signature *

Clear
Should be Empty:

Application for 2021/22 Ordinary Membership