2017 Australian Broomball Championships Player Registration Form

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Please select your state and enter registration password.
State:
Password:

Please enter your details below to register.

Player Details

First Name: *
Last Name: *
Date of Birth: *

Since you are under 18 years of age, you are required to seek permission from your parent or guardian to allow you to play in this tournament.

I hereby grant permission for my child to play in the Australian Broomball Championships 2017.
Parent/Guardian: *

Gender: Male Female *
Email: *

Team Details

Select your Team(s) (Hold CTRL to select multiple):
Jersey Number:

Presentation Night

Attending Presentation Night ($60/head)

Number Attending:
Dietary Requirements:
(specify per person):

Emergency Contact

Name: *
Phone: *
Relationship: *

Conduct Agreement

I have read and agree to the IceArenA Ice Sports Rules and Guidelines *
I have read and agree to the Terms and Conditions of Entry and Indemnity Disclaimer *
I have read and agree to the BASA & SAISF Liability Waiver *