Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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WWCC Expiration Date *

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DD

YYYY

I have completed the Harassment and Discrimination Training *

A link to the free online training is listed below.

I have emailed the Harassment and Discrimination certificate to saseafordbasketball@gmail.com *

A link to the free online training is listed below, you will receive a certificate upon completion, please email this to the Avengers committee.

I have printed, signed and had witnessed the Member Declaration *

A link to the form is listed below this form