BASA Membership Form

Please enter your details below to register.

Email: *
Password: *
Confirm Password: *
First Name: *
Last Name: *
Date of Birth: *
Gender: Male Female *

Contact Details

Address Line 1: *
Address Line 2:
Suburb/City: *
State/Province: *
Post Code: *
Country: *
Phone(W):
Phone(H):
Phone(M):
Fax:

Emergency Contact

Name: *
Phone: *
Relationship: *

Fees

BASA Membership is paid annually and is valid for 1 year from July 1^st to June 30^th the following year. Fees for the 2022/23 year are as follows:

Members: $100 (due 31^st July)
New Members:
- Join before January 1^st: $60 (due 1 month after joining on 26/12/22)
- Join on or after January 1^st: $10 (due 1 month after joining on 26/12/22)

New members fees are due 1 month after joining.

Members must ensure their fees are paid and current before playing.

Conduct Agreement

I agree to pay the BASA Membership Fees by the due date *
I have read and agree to abide by the Broomball Association of South Australia Inc. Constitution *
I have read and agree to the BASA By-Laws *
I have read and agree to the Ice ArenA Ice Sports Rules and Guidelines *

COVID-19 Policy Agreement

I have read and agree to the IceArenA COVID-Safe Plan - Step 3 *
I have read and agree to the IceArenA COVID-19 Additional Protocols *
I have read and agree to the BASA COVID-19 Policy *

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