[icons icon="fa-envelope" size="fa-lg" type="normal" custom_size="19" target="_blank" icon_color="#f9bc33" icon_hover_color="#ffffff" margin="0 0 0 23px"]

info@memphisislamiccenter.org

Muslim Basketball League

MBL

Muslim Basket League of Memphis Individual Registration Form

League Fee $25.00 per player
Registration Dates October 19, 2012 – November 11, 2012
Season Dates November 16, 2012 – February 10, 2013

Pay Online or Make checks payable to:

[icon_text box_type=”normal” icon=”fa-map-marker” icon_type=”circle” icon_position=”left” icon_size=”fa-lg” use_custom_icon_size=”no” separator=”no” text=”Muslim Basketball League of Memphis
10225 Humphrey Road
Cordova, TN 38018″ icon_border_color=”#ffc425″ icon_color=”#ffc425″ icon_hover_color=”#ffffff”][icon_text box_type=”normal” icon=”fa-phone” icon_type=”circle” icon_position=”left” icon_size=”fa-lg” use_custom_icon_size=”no” separator=”no” link=”tel:(901) 238-5017″ link_text=”(901) 238-5017″ link_icon=”yes” icon_border_color=”#ffc425″ icon_color=”#ffc425″ icon_hover_color=”#ffffff”]
First Name *
Field is required!
Field is required!
Last Name *
Field is required!
Field is required!
Street Address *
Field is required!
Field is required!
Date of Birth *
Field is required!
Field is required!
City *
Field is required!
Field is required!
Zip Code *
Field is required!
Field is required!
Parent/Guardian (if under 18) Full Name
Field is required!
Field is required!
Home Phone
Please enter numeric value
Please enter numeric value
Cell Phone *
Field is required!
Field is required!
Email *
Field is required!
Field is required!
Jersey Size *
Field is required!
Field is required!
Jersey Number (availability not guaranteed) *
Field is required!
Field is required!
Team Affiliation (if no team, leave blank) *
Field is required!
Field is required!
Skill Level (check one) *
Field is required!
Field is required!
List most convenient times for league play (check all that applies) *
Field is required!
Field is required!
I, the player, or parent/guardian of the above named player, hereby give my approval of his participation in all basketball activities during the current season. I/We assume all risks and hazards incidental to such participation. I/We do hereby waive, release, absolve, and agree to hold harmless the Muslim Basketball League of Memphis and/or their organizers and officials from any claims that might arise from injuries sustained while participating in this program. State your full name below as a statement of agreement: *
Field is required!
Field is required!
Submit