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BSL 2012 Player Waiting List Sign-Up Form

Name (required) First Name Last Name Gender Male Female

Address

Contact (provide a Phone Number or E-Mail Address or both) Phone E-Mail

Division or Age Category (required for male players) Division Open Age (ages 18 and over) Over 30 (ages 30 and over) Over 41 (ages 41 and over)

What position(s) do you wish to play? First Choice <Any> Defender Midfielder Forward Goalkeeper Second Choice <Any> Defender Midfielder Forward Goalkeeper

If you wish, you can provide us with additional information here. Such as your playing experience or how competitive a division you wish to play in.