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MEMBERSHIP APPLICATION

First Name

Phone (preferred number)

Last Name

Birthday

Address (Street, Town, Postal)

Email

I play and/or coach a local team (name team)

Availability

I can ref weekends

I can ref weekdays before 4pm

I can ref weekdays between 4pm and 6pm

I can ref weekday evenings after 6pm

Previous Experience

Player: high school

Player: post-secondary

Coach

Referee

If you've referred basketball previously, please indicate your years of experience and for which association.

Thanks for submitting!

Contact us

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Last name

Email*

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