BC Breakers Annual Festival 2018 Registration Form
BC Wheelchair Basketball Society and BC Breakers welcome you to attend this fun filled festival on February 17-18 in Victoria!
We will be at Spectrum Community School for the weekend's events
Registration deadline is Jan 16, 2018
start
 
What's your full name? *

 
Are you a current member of BCWBS for the 2017-18 season?

Individual member - Filled out a BCWBS membership form and paid $35 (19+) or $20 (U19) to BCWBS.
Club member - A member of one of the regional wheelchair basketball clubs in BC.

 
Please select your registration option: *

Note: If you have any questions about accommodations, please email or call us. 604-333-3530 | info@bcwbs.ca
Accommodation information will be emailed out, we have a pre-arranged set-up with the Accent Inn.

 
Do you need to borrow a sport wheelchair from BCWBS? *

We encourage you to bring your own if possible.
     
 
Please write here if you have any questions or have any health concerns.

 
Please read the consent and waiver below and accept the terms. 
- If you are under 19 years old, please make sure to read this with your parent/guardian and accept the terms with her/him. *

I, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, consent to and assume all risks and hazards of and incidental to my participation in the activities of the BC Wheelchair Basketball Society and forever release, discharge and hold harmless BC Wheelchair Basketball Society and all other parties, including agents, other associations and sponsoring companies, connected with BCWBS programs and events for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in the BCWBS activities and notwithstanding that the same may have been contributed to or occasioned by the activities of BC Wheelchair Basketball Society and all other parties, including agents, servants and volunteers of BC Wheelchair Basketball Society, other associations and sponsoring companies. I also give full permission for use of my name and/or photograph/image in connection with BCWBS publications, website & other promotional materials.* We respect your privacy, and will not sell or share your personal information with any other party or organization without your consent
     
 
Your total fee is {{var_price}}

 
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 your registration.
Powered by Typeform
Please contact BCWBS (604-333-3530 or info@bcwbs.ca) or
go to this link (https://bcwbs.typeform.com/to/Xl7vra) to sign up for the membership.
again
Powered by Typeform
Powered by Typeform