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Youth Basketball League Special
Youth Basketball League Registration - SPECIAL 2024-25
I am registering
(Required)
A Team
CHURCH/SYNAGOGUE INFORMATION
Name of Church/Synagogue
(Required)
Church/Synagogue Contact Name
(Required)
Note, this must be a person employed by the church/synagogue. This is used to verify the team is actually from this church/synagogue
Church Contact Phone
(Required)
Church Contact Email
(Required)
TEAM INFORMATION
Division
(Required)
7th & 8th (Boys)
9th & 10th (Boys)
11th & 12th (Boys)
High School (Girls)
Coach Name
(Required)
First
Last
Note, if you don't have a coach yet, put the church contact in this spot.
Coach Phone Number
(Required)
Coach Email
(Required)
List
Player Name
Emergency Contact Name
Emergency Contact Number
Add
Remove
PAYMENT INFORMATION
Team Price
(Required)
Price:
Total
Credit Card
(Required)
Cardholder Name
Card Details
Δ
If you have any questions, contact
hdoherty@phumc.com
or call 501-664-3600.
