The following information will be treated as private and confidential and will only be used by the Club for Baseball Victoria registration as well as a means of communication with the member.
Items marked with an * are required to be completed.
Surname *
Given Name(s) *
Date of Birth * dd/mm/yyyy
Sex Male Female
Age Group Seniors U/18PS U/18 U/16PS U/16 U/14 U/12 TeeBall (5-10) Masters as at 31st Dec
Residential Address
Postal Address (if different from Residential)
Home Phone
Mobile Phone
Email *
Occupation
Contact Name
Relationship
Contact Phone
Can an ambulance be called for you if required: Yes No
Known medical condition(s)
Parent/Guardian Name
Parent/Guardian Phone
Parent/Guardian Mobile
Parent/Guardian Email
Parent/Guardian Occupation
Terms and conditions * I, the player named above, agree to pay all fees and levies prior to the commencement of the season. I agree to abide by the association and club by-laws, codes of conduct and rules.
NOTE: Your email address and mobile number (for SMS) will be used by the Club as the main form of communication. It is your responsibility to inform the Club if these details change.
Press the "Send" button to send the information to the Club.
