June 2015 NCCP Community Coaches Clinic Registration

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Welcome to the Basketball Manitoba NCCP Clinic Registration page. Please complete this form in full and click the 'Continue' button at the bottom to proceed.

If you are registering multiple people for the clinic, you will need to return to this page and register them one at a time.

*** Deadline to register for the clinic is Thursday, June 18, 2015 at 5:00 pm ***

STEP 1 - Personal Information

Your information will be used for Basketball Manitoba communication purposes only as per our privacy policies. http://www.basketballmanitoba.ca/2013/01/basketball-manitoba-privacy-policy.html

First Name *

Last Name *

Email Address *

Mailing Address *

City / Town *

Postal Code *

Home Phone *

Work Phone

Cell Phone

Gender *

Date of Birth *

To be used for NCCP Certification needs.

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