* Required fields # of individuals you want to register: 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308309310311312313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416417418419420421422423424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468469470471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500
First Name * Last Name * Gender * Male Female Non-binary City Club Apply to all DOB (YYYY/MM/DD) * / / Membership Specific InformationGOLD Membership: Includes everything in Silver plus participation in Open and National Events. SILVER Membership: Includes everything in Bronze plus participation in Provincial events. BRONZE Membership: Allows access to webinars, virtual events, coach and official education opportunities and insurance. Primary Membership Role Select...GOLD MembershipSILVER MembershipBRONZE Membership No events available. Category Select category…Age 1-12Age 13-18Age 19-54Age 55+ No categories available for this age. NB Racquetball Membership *Select…Standard MembershipPremium Membership LEVEL STANDARD PREMIUM BRONZE $10.00 $30.00 SILVER $15.00 $45.00 GOLD $30.00 $60.00 Member Contact Information Address * Address 2 City * Province *Select…AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code * Region Email * Cell Phone Work Phone I agree to receive email communication from Racquetball Canada related to information about news, events and opportunities for me to be engaged in the sport. I can opt out of this communication at any time. Racquetball Canada does not share or sell any private information. *Select…YesNo I agree to receive email communication from Racquetball New Brunswick about about news, events and opportunities for me to be engaged in the sport. I can opt out of this communication at any time. Racquetball New Brunswick does not share or sell any private information. *Select…YesNo I agree to receive email communications from my local racquetball club about news, events and opportunities for me to be engaged in the sport. I can opt out of this communication at any time. Racquetball Canada does not share or sell any private information. *Select…YesNo Additional InformationSport Canada would like to know a few things about you. Para-athleteSelect…NoYes Canadian CitizenSelect…YesNo Birth Country IndigenousSelect…NoneFirst NationsInuitMétis New CanadianSelect…NoYes Health Card # Coach Specific Information NCCP # Criminal Record Check (Submitted Date) Criminal Record Check (Completed Date) Criminal Record Check (Expiry Date) Respect in Sport Certification # Official Specific Information Official Level Official Level date achieved Emergency Contact Information Emergency Contact Name Emergency Contact Phone Emergency Contact Email Parent/Guardian Information Parent/Guardian Name * Parent/Guardian Phone * Parent/Guardian Email * Before clicking the "PROCEED TO STEP 2" button make sure to input ALL registrant data first. To switch between different registrants you can click on their name to the left of the registration form or if a name is not assigned yet click on "(+) BLANK ENTRY" to open a blank form. PROCEED TO STEP 2 ADD ANOTHER REGISTRANT
