Individual Registration Form - EASTERN LEAGUE

First Name(*)
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Last Name(*)
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Date of Birth
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Street
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City
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Postcode
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Mobile Phone
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Daytime Phone
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Evening Phone
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Email
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Last Years Team
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to be filled out IF you have played the previous season

Gender
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Fee Structure

Individual registration fee

If paid prior to October 3rd

$50.00

$45.00

Team registration fee

If paid prior to October 3rd

$480.00

$430.00
Bank account information

Kiwibank

38-9003-0141088-00
Reference

Your last name/ team name

Softball Experience
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To assist us in placing you on a team, please indicate your level of softball experience

Amount Paid $
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Anti Spam(*)
Anti Spam
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Please type the letters in the box above as they appear on your screen