Mens (Big Ballers) League Registration

US$109.99

Age

Jersey Size

Experience Level

Injury Agreement

“I AGREE" to take full personal responsibility in participating in this activity that may result in injury or even death. I also agree to release Achi3v3 Basketball & Lake Nona Performance Club from any responsibility at all in the case of injury.

First Name

Last Name

Home Address

Email Address

Phone Number

Requested Jersey #

(Type in 2 different numbers: example 23 or 5)

Child Playing too ?

Type in Child’s Grade / & Name Below:: (or) Type “NO” if no child is playing, just you::

Who Referred you ?

(if no one, type “NONE”)

Quantity