BCWBS Affiliate Club Registration Form
Welcome to 2017-18 Wheelchair Basketball Season!
Please fill out the form to register your club as a BCWBS affiliate member for the season (Sept 1, 2017 - Aug 31, 2018).
For more information about the membership, please visit http://bcwbs.ca/about-us/membership.
Become a Member
What is the name of your club? *

Please type the official club name which can be used on receipts, invoices, cheques, etc.
What is the name of the club representative? *

Can we share this email address to public? *

websites, social media, etc.
What is the phone number that we can reach the club representative at? *

Is this number for... *

Please tell us the mailing address of the club (or club representative)? *

Please write a full address including Street, City, Province, and Postal Code.

Letters, cheques, etc. will be sent to this address by BCWBS when applicable.
Please tell us your club website/social media info if available.

You can add a new row by pressing "alt + enter".
When was the club established?

Please let us know month/year if you know.
Please read and agree to 
the terms below by accepting these terms on behalf of the club: *

1.0   The club understands that only members whose information submitted to the BCWBS as per club membership requirement are covered by the insurance provided by BCWBS.
2.0    The club agrees to submit reports in the timeframe requested by BCWBS to stay as a member in good standing. 
3.0   The club understands that the club membership is only for wheelchair basketball participants in our programs and does not apply to other wheelchair sports such as tennis, rugby and athletics.
4.0   The club will designate a representative to take part in the season start and season end regional club conference call. 
5.0   The club will send one representative, paid for by BCWBS, to the annual regional conference held in Vancouver.
6.0   The club will make the best effort to follow the wheelchair basketball LTAD (Long Term Athlete Development model) and engage in improving its coach(es) to support the club development.
Please select one of the fee options below. *

If you choose a cheque option, the cheque must be received by BCWBS within a week otherwise your club membership will not be valid.

Your total fee is {{var_price}}. Please fill in your payment information below. *

Please enter your Credit or Debit Card number: *

The CVC number: *

(3 or 4 digit security number on the back of your card)
The name on your card: *

Your card's expiry month: *

Your card's expiry year: *

Thank you for registering your club for the 2017-18 Season.
Please note that you will also need to submit the club members registration form for a proper insurance coverage. 

If you are mailing a cheque, please send it to:
780 SW Marine Dr.
Vancouver BC V6P5Y7

The information provided on this membership enrollment form is collected and maintained by BC Wheelchair Basketball Society solely for the purposes for which it is intended and shall not be used for any other purpose or disclosed without the prior consent of members.  
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