Member Registration form PACA - Prince Albert Cricket Association

REGISTRATION FORM – YEAR: 2025

PACA Member Registration 2025

Member Personal Details

*Submission Deadline: April 15, 2025

First Name

Last Name

Birth Date

Phone Number

Address

City

Province

Postal Code

Country

Emergency Contacts

Emergency Contact#1 First Name

Emergency Contact#1 Last Name

Relationship

Phone Number

Emergency Contact#2 First Name

Emergency Contact#2 Last Name

Relationship

Phone Number

Membership Type

Club Name

Player Specialty

Membership Fees

We request you to please pay the membership fees in full amount by Interac e-Transfer (email transfer) to finance@pacricketassociation.com If you have any questions related to membership, please contact us at info@pacricketassociation.com

$25 Membership Fees paid by e-transfer?

Yes

$1.00 Membership Fees paid by e-transfer?

Yes

If Yes, Type confirmation code and date here:

If No, Please pay the fees first before submitting this form.

I have read and agree to the Code of Conduct and Rules & Regulations.

I have read and agree to the PACA’s Social Media Publication & Privacy Policy.

I hereby signify my willingness to play with the mentioned team & club and to accept the conditions and rules pursuant to the Bylaws of Prince Albert Cricket Association.