Mens Basketball League - Registration

1
Team Role* This field is required.
Team Captain
Free Agent Player
2
How many years experience with adult basketball leagues?* This field is required.
less than 1 year
1 year
2-4 years
3-5 years
5+ years
3
On a scale of 1-10, how would you rate your overall basketball skills?* This field is required.1-amature to 10-professional
4
Your Name* This field is required.
First Name
Last Name
5
Team Name
6
Player Names
7
Date of Birth* This field is required.
Date
Year
Month
Day
8
Phone Number* This field is required.
Area Code
Phone Number
9
Email* This field is required.
example@example.com
10
What's your shirt size?* This field is required.
S
M
L
XL
2XL
3XL
4XL
11
Emergency Contact* This field is required.
First Name
Last Name
12
Emergency Contact Phone Number* This field is required.
Area Code
Phone Number
13
Rules & Regulations* This field is required.
14
Are you covered by personal/family insurance?* This field is required.
Yes
No
15
Name of Insurer
First Name
Last Name
16
Policy or Group #
17
Participation Waiver* This field is required.
18
Payment* This field is required.
prevnext( X )
My Bag
2
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Free Agent Player
$80.00+Edit
Back
Team Registration Fee
$640.00+Edit
Back
Total cost $0.00
Credit Card
First Name
Last Name
19
Signature* This field is required.I agree that all information is correct, to the best of my knowledge.
Should be Empty: