Download and print our player registration form

Player Registration Form

Valid to: ..............................................................

Membership Number:...........................................

$70.00       Gold            12 Months
$40.00       Silver            5 Months
$40.00       Student        12 Months
    (17 years and under)
              Junior Sport       6 Months

I................................................................................................................................. desire to become a

Gold Silver Student Junior Sport (tick whichever is applicable) Member of Action Indoor Sports

(NSW) Pty Ltd (AIS).

Date:..............................................

Surname:............................................................. Given Names:..............................................................

Address:............................................................. Suburb:...................................... P/Code:...................

Home Phone:.................................. Work Phone:................................... Mobile:...................................

Email address:..........................................................................................................................................

Contact person, in case of emergency:...................................................... Phone:....................................

...............................................................................................................

Date of Birth:........................................................................................... Amount Paid $........................

Joining Date:.............................................................................................................................................

GAME TYPE	DAY of WEEK	AM/PM	TEAM NAME	CAPTAIN?
		am pm		Yes No
		am pm		Yes No
		am pm		Yes No
		am pm		Yes No
		am pm		Yes No
		am pm		Yes No

----------------------------------------------------------------------------------This section for AIS only

Comments.......................................................................................................................................................................................

.........................................................................................................................................................................................................

Code: A................. B................. C.................

Computer	Centre	Entered by	Date