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:

Muslim Basketball League of Memphis
10225 Humphrey Road
Cordova, TN 38018

First Name *
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Field is required!
Last Name *
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Field is required!
Street Address *
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Field is required!
Date of Birth *
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Field is required!
City *
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Field is required!
Zip Code *
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Field is required!
Parent/Guardian (if under 18) Full Name
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Field is required!
Home Phone
Please enter numeric value
Please enter numeric value
Cell Phone *
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Field is required!
Email *
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Field is required!
Jersey Size *
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Field is required!
Jersey Number (availability not guaranteed) *
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Field is required!
Team Affiliation (if no team, leave blank) *
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Field is required!
Skill Level (check one) *
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Field is required!
List most convenient times for league play (check all that applies) *
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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!