Basketball PEI Membership Form
To become a member of Basketball PEI for the 2017-2018 year (September 1st - August 31st), fill in the form below. The membership fee is $40 and is due upon completion of the form.

For any additional questions, please contact the Basketball PEI office at (902)368-4986 or info@basketballpei.ca.

Last Name *
Your answer
First Name *
Your answer
Gender *
Organization *
Required
Membership *
Required
Permanent Address *
Your answer
City *
Your answer
Postal Code *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Present Grade *
E-mail Address *
Your answer
Parent/Guardian Name(s) *
Your answer
Telephone Number *
Your answer
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