Southern Districts Basketball
U14 Talent Identification Program
Athlete Name
*
First Name
Last Name
Gender
Please Select
Male
Female
Non specified
Athlete DOB
-
Month
-
Day
Year
Date
Reversible Singlet Size
Please Select
Youth Size 8
Youth Size 10
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
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Primary Contact Name
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Primary Contact Mobile
*
Please enter a valid phone number.
Relationship to Player
*
Secondary Contact Name
*
First Name
Last Name
Secondary Contact Email
example@example.com
Secondary Contact Mobile
*
Please enter a valid phone number.
Relationship to Player
*
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PAYMENT
Payment is required to confirm registration in U14 Talent Identification Program
My Products
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Categories:
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( X )
3 x Talent Identification Sessions + reversible singlet
$
150.00
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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