2001 Registration Application

Have you attended an EBA program before? _____N _______Y When? ___________________

Financial Responsibility for this participant will be assumed by: ____Self ____Guardian ___Other______________________________________

If different from above address, all mail should be sent to: ____________________________

_______________________________________________

Emergency Contact Name: ___________________ Relationship to applicant:______________

Home Phone: _____________________________ Work Phone: _______________________

A $50 nonrefundable deposit and $25 registration fee are due with the application. Make checks payable to: Educators Basketball Association. All fees are due by the first day of enrollment in any EBA program.. There is an additional $25 fee for returned checks. Once a registration application and deposit are received, no refunds are given for voluntary withdrawal. No refunds are given for missed days. Refunds are only issued in the event that no openings exist in the requested program(s) or in the event that EBA must cancel published programs or services due to insufficient enrollment. All required health forms must be on file before the first day of attendance in any EBA Program. Enrollment will be terminated for any participant whose health forms are not on file before they begin attendance. We reserve the right to dismiss, without a refund, any participant for inappropriate or unsafe conduct. We reserve the right to use photographs or videos taken during our programs in our promotional materials. We reserve the right to cancel any course, class, program or service for insufficient enrollment.

I have read and understand all EBA policies and fee schedules. ________________________________________

Signature of person completing this form

_____Check Number Amount: ___________

Please indicated desired program(s) and date(s):

____ Elite Training Program, Date(s):_____________________________

____ International Basketball Exchange Program, Date(s):_____________ 

____ Academic Readiness and Mentoring Program, Date(s):___________

____ Golf Youth Initiative, Date(s):________________________________ ____________________________________________________________

For Office Use Only

Date received:________________ Balance Due: _____________________
Amount:_____________________ Program: _________________________