Cockburn Basketball Association Individual Nomination Form WANT
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Cockburn Basketball Association Individual Nomination Form WANT TO PLAY BASKETBALL??? Fill in the information below and we will pass on your information to our clubs for you to be placed in a team. Name: _________________________ Date of Birth: _______________ Address: __________________________________________________ Phone: ________________ Email: _____________________________ Have you played before: Y / N Where/When: __________________ Please indicate which division you want to play: AGE GROUP UNDER 9 MIXED UNDER 10 BOYS UNDER 12 BOYS UNDER 14 BOYS UNDER 16 BOYS UNDER 18 BOYS SENIOR MENS MENS VETS UNDER 10 GIRLS UNDER 12 GIRLS UNDER 14 GIRLS UNDER 16 GIRLS UNDER 18 GIRLS SENIOR WOMENS BIRTHDATES 2003/2004 2002/2003 2000/2001 1998/1999 1996/1997 1994/1995 Over 16 years old Over 35 years old 2002/2003 2000/2001 1998/1999 1996/1997 1994/1995 Over 16 years old DAY OF PLAY SATURDAY MORNING MONDAY AFTERNOON FRIDAY AFTERNOON FRIDAY AFTERNOON WEDNESDAY AFTERNOON/NIGHT WEDNESDAY AFTERNOON/NIGHT MONDAY or TUESDAY NIGHT TUESDAY NIGHT TUESDAY AFTERNOON TUESDAY AFTERNOON TUESDAY AFTERNOON WEDNESDAY AFTERNOON/NIGHT WEDNESDAY AFTERNOON/NIGHT MONDAY NIGHT DIV 1 DIV 2 Cockburn Basketball Association Starling Street Hamilton Hill PH: 9335 9101 Fax: 9430 6277 Email: development@cockburncougars.com Web: www.cockburncougars.com Office Use Received by: ____________________________ Date: _____________ Cockburn Basketball Association Individual Nomination Form WANT TO PLAY BASKETBALL??? Fill in the information below and we will pass on your information to our clubs for you to be placed in a team. Name: _________________________ Date of Birth: _______________ Address: __________________________________________________ Phone: ________________ Email: _____________________________ Have you played before: Y / N Where/When: __________________ Please indicate which division you want to play: AGE GROUP UNDER 9 MIXED UNDER 10 BOYS UNDER 12 BOYS UNDER 14 BOYS UNDER 16 BOYS UNDER 18 BOYS SENIOR MENS MENS VETS UNDER 10 GIRLS UNDER 12 GIRLS UNDER 14 GIRLS UNDER 16 GIRLS UNDER 18 GIRLS SENIOR WOMENS BIRTHDATES 2003/2004 2002/2003 2000/2001 1998/1999 1996/1997 1994/1995 Over 16 years old Over 35 years old 2002/2003 2000/2001 1998/1999 1996/1997 1994/1995 Over 16 years old DAY OF PLAY SATURDAY MORNING MONDAY AFTERNOON FRIDAY AFTERNOON FRIDAY AFTERNOON WEDNESDAY AFTERNOON/NIGHT WEDNESDAY AFTERNOON/NIGHT MONDAY or TUESDAY NIGHT TUESDAY NIGHT TUESDAY AFTERNOON TUESDAY AFTERNOON TUESDAY AFTERNOON WEDNESDAY AFTERNOON/NIGHT WEDNESDAY AFTERNOON/NIGHT MONDAY NIGHT DIV 1 DIV 2 Cockburn Basketball Association Starling Street Hamilton Hill PH: 9335 9101 Fax: 9430 6277 Email: development@cockburncougars.com Web: www.cockburncougars.com Office Use Received by: ____________________________ Date: _____________
