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VCYBC Basketball On-Line Membership Application Form

Directions for filling out the on-line application:
  • Please enter the required information on the fields below.
  • Specify the school nearest to your home for accurate mileage fees computations
  • For all phone numbers, please enter the information using this format: xxx-xxx-xxxx
  • Information submitted on this form will be electronically sent to the Unit Secretary: Teresa Moore at TheVLeague@yahoo.com.

    • NOTE:If you already have applied to another sport within this association, it is NOT necessary to file an new membership application. Contact the secretary- treasurer or the assignor to have your account activated.

    Personal Information
    First Name Middle Name Last Name
    Address
    City State Zip
    Email
      School Nearest Home
      School Nearest Work
    Home
    (xxx-xxx-xxxx)    		 Work
    (xxx-xxx-xxxx)
    Pager
    (xxx-xxx-xxxx)    		 Cell
    (xxx-xxx-xxxx)
    Fax
    (xxx-xxx-xxxx)
    Have you ever been convicted of a crime?
    If yes,
    please explain


    Experience
    Level Experience
    Level    		 Assignor Phone Number
    (xxx-xxx-xxxx)
    College?
    High School?
    Youth?
    Comments


    Last Unit or Organization Information
    Unit/Organization Name:
    Assignors Name Phone Number
    (xxx-xxx-xxxx)
    Instructors Name Phone Number
    (xxx-xxx-xxxx)
    Reason For Leaving