Senior Membership Registration 2018 Go back to membership page. 2018-19 Senior Membership Player Name* First Last Phone Number*This number will be used as the primary contact for all communications from the club.Email Address* Address Street Address City County Gender*FemaleMaleDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Medical Conditions or AllergiesPlease specify if this child has any medical conditions (e.g. Asthma, dyspraxia etc.) that our coaches should be aware of.Previous Club?If this is the first time your child is registering with the club, were they ever a member of another Irish Basketball Club?NoYesName of previous club*Please note that you may have to complete a player transfer form in order to join the club. This is available to download from the titans.ie/registration page.Terms & Conditions & Getting InvolvedDATA PROTECTION Titans Basketball Club is committed to ensuring it meets the specific responsibilities set out in the Data Protection Act 2018. Members of Titans Basketball Club are also members of Basketball Ireland, the National Governing Body for Irish Basketball, and membership details are passed to Basketball Ireland. In order for the club to function, your personal details will, from time to time, be shared with other members in the club, i.e. the executive committee, registrar, managers, coaches etc. Members who play under the Galway and Regional Area Boards may have their names and dates of birth, and other personal details, given to these Area Boards. PERSONAL ACCIDENT INSURANCE Titans Basketball Club does not provide Personal Accident Insurance for members. PARENT / GUARDIAN DECLARATION I have been made aware that Titans Basketball Club has developed a Child Protection Policy and that they are committed to ensuring the safety of my child by having; A Coaches / Volunteer Charter A Transport Policy An Anti-bullying Policy Public Liability Insurance Disciplinary Procedures A Designated Child Protection Officer A Photography Policy Copies of all these policies, along with procedures for complaints and contact details of the Child Protection Officer are available on the club’s website www.titans.ie or from any Committee Member I give my consent for my child to be photographed in line with this policy. Your child may be recorded during training and games as part of the team, and these recordings / photographs may be used on social media / website for promotional and/or for training materials. I will inform the Coaches of any important changes to my child’s health, medication or needs and also of any changes to our address or phone numbers given. In the event of illness, having parental responsibility for the above named child/children, I give permission for medical treatment to be administered where considered necessary by a nominated First Aid provider, or by a suitably qualified medical practitioner. If I cannot be contacted and my child should require emergency hospital treatment, I authorise a qualified medical practitioner to provide emergency treatment or medication. To assist with supervision at coaching sessions throughout the season I am willing to allow my phone number to be circulated, on a list, to parents of members of Titans Basketball Club. The Parent/Guardian further confirms that the details contained herein are correct to the best of his/her knowledge; that they have parental responsibility for the member applicant and gives parental consent for the child to participate in and travel to all activities.We are an entirely voluntary body, and as such, it's you, the members, who help us to thrive. Please tick one / all of the boxes in areas where you think you could help us.Volunteering I am willing to assist in supervising at the door / roll call I would like to get involved with coaching the kids I would be willing to manage a team (send texts / organise kit etc) I would like to find out about becoming a referee I would like to find out about coaching courses I would like to find out how to become a table official NotesPlease provide any further information you think may be relevant - e.g. if registering additional adults / students and juvenile members.PaymentPlease Select Membership Type*Adult Member [€250]Juvenile National League Player [€180]Full Time Student [€180]Wheelchair Player [€160]Family Rate [€350]Masters Player [€40]Volunteer / Coach / Manager [€0]Non playing memberTotal Membership Fee 0,00 € Payment Method*If paying by cash, please contact *protected email* as soon as possible with payment as we cannot register you until payment has been received.CashCredit CardCredit Card* MasterCardVisaMaestro Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name Agreement to membership terms and conditions*Please type I AGREE to indicate that the details provided on the form are accurate, and that you agree to abiding by the terms and conditions as laid out above. 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