GCBSS Coach Membership Form

To complete an ONLINE REGISTRATION you must pay through PayPal. You can not fill out the form now and make a payment at a later date.

* Required information.

For submitting your data don't fill this following email field:

PERSONAL INFORMATION:
Family Name *
Given Name *
DOB (dd/mm/yyyy format) *
Gender *
Postal Address *
Suburb *
Pcode *
Coach's email *
Home phone
Coach's mobile
Parent/Guardian Name
Parents mobile
School
MEMBERSHIP CATEGORY: Coach - $27.00 for 12 month membership
Category *
TEAM INFORMATION: Please enter information below for the team you are registering for. (if you are unsure please leave blank)
Association *
Team Name
Age Division *
CONDITIONS: "I hereby acknowledge that if I participate in any competition conducted under the auspices of Gosford City Basketball & Sports Stadium, I will be bound by the tribunal by-laws as adopted and varied from time to time by Gosford City Basketball & Sports Stadium and Basketball New South Wales Association Limited. I further acknowledge that I have been afforded the opportunity to inspect by-laws at the time of completing this application form"
I agree to the conditions above *
From time to time, Gosford City Basketball & Sports Stadium may use the names and images of its members in newsletters, media releases and websites. Please indicate below if you do not giver permission for your name or image to be used
I agree for name and photo to be used *
PAYMENT TYPE:
Payment Option *
Once your transaction is complete through PayPal, please write down your "Paypal Receipt Number". Once Your payment is finalised you will be directed to a 2nd form you MUST COMPLETE in order for GCBSS to complete you membership online.