Beginner Referee School Expression of Interest

Become a Referee

Expression of Interest
Fill out this form if you are interested in becoming a referee at Mackay Basketball

Please note that you must be 12 years old to become a referee

By completing this form, you will be registered as a referee on Basketball Connect & receive email communication about our next referee school

If you have any questions, please email comps@mackaybasketball.com.au
Full Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name

First NameLast Name
Parent/Guardian's Email
example@example.com
Parent/Guardian's Phone
Please enter a valid phone number.Format: (000) 000-0000.
Bank Details
Please provide your Bank Name, Account Name, BSB & Account Number (if you don't know your bank account details, you will need to provide this information at a later date)
What days of the week are you available to referee? (select all that apply)
If you currently play basketball, which Club do you play for? (select all that apply)
Should be Empty:

Become a Referee