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Create a new account

- Name
- First Name*
- Last Name*
- Nickname
- Date of Birth*
- Age Confirmation*
  - I confirm that I am 18 years of age or older
  - I am less than 18 years old
- Parent/Guardian Consent
  You must have consent from your parent or guardian to participate in Broomball if you are under 18 years old.
- Parent/Guardian First Name*
- Parent/Guardian Last Name*
- Parent/Guardian Phone* Required phone number format: (###) ###-####
- Parent/Guardian Email*
- Gender*
  - Male
  - Female
- Contact Info
- Phone (M) Required phone number format: #### ### ###
- Phone (W) Required phone number format: (##) ####-####
- Phone (H) Required phone number format: (##) ####-####
- Address Line 1*
- Address Line 2
- Suburb / City*
- State*
- Post Code*
- Country*
- Login Details
- E-mail* This is also the username that you will use to login to the BASA site.
- Password* Minimum length of 8 characters.
  The password must have a minimum strength of MediumStrength indicator
- Repeat Password*
- Emergency Contact
- Name*
- Phone* Required phone number format: +## # #### ####
- Email*
- Relationship*
- Membership
  New members use discount code BASAINTROFULL at checkout.
  BASA Membership - $120.00 until 30 June 2024
  Broomball Association of South Australia membership for current members/players. BASA members are entitled to enter local and representative Broomball competitions.
  WARNING!You will be able to complete the payment after you have confirmed your email address.
- 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*
- Data Agreement
- I allow the website to collect and store the data I submit through this form and agree that BASA can contact me regarding my membership and Broomball competitions.*
- *

Create a new account

Name

Parent/Guardian Consent

Contact Info

Login Details

Emergency Contact

Membership

Conduct Agreement

Data Agreement

GDPR