1. Pinoy Basketball Australia
Application for Player Membership
Name:_________________________________________ D.O.B. (dd/mm/yy)_________________
Address: (No. & Street Name) _____________________________________________________
(Suburb) __________________________________________ Postcode: ____________________
Phone No. (H) _____________________________ Mobile:______________________________
Email Address: _________________________________________________________________
Team Name:____________________________ Occupation: ____________________________
Emergency Contact:
Name: ________________________________________Contact No. _______________________
I agree to be bound by the constitution and rules of the Pinoy Basketball Australia for the
period of registration specified. I give permission for any photographs taken by the Pinoy
Basketball Australia to be used for promotional purposes.
Player’s Signature: ____________________________________ Date:
______________________
Junior Players Only (under 18): Parent/Guardian must sign on player’s behalf
Parent/Guardian Name: (please print)
__________________________________________________
Parent/Guardian Signature: ____________________________ Date:
_____________________