Team / Activity Selection:


First Name (required)

Surname (required)

Date of Birth: (in some browsers, reqd format is yyyy-mm-dd)

Nationality (required)


Player Address:

School Name (if applicable or N/A)

School Year as of Sept 2017 (if applicable or N/A)

Parent/Guardian Name (required)

Parent/Guardian Relationship:

Parent/Guardian Email (required)

Parent/Guardian Home Phone Number (required)

Parent/Guardian Mobile Phone Number (required)

Parent/Guardian Address:

Other Details:
(Medical conditions, dietary requirements, allergies etc, if none add N/A)

Please bank transfer the correct amount for your membership to the following bank account with your name and team.

Account Name: City of Birmingham Basketball Club
Bank: HSBC
Account Number: 71487442
Sort Code: 40-32-03