NWBA Division 1 Draft Application

*** Users of web based email systems such as AOL, Yahoo, MSN, etc
must fill out the form then cut and paste into an email message. Then email Dug Jones to verify receipt of application. ***

First Name:		Last Name:
Address:
City:		State: Zip:
	Male Female	Shirt Size:
Home Phone:		Work: Cell:
E-mail:
NWBA Team:		Coach:
NWBA and/or IWBF Classification:		Disability:
Position:		Height: Weight:
Basketball Honors:

	I,(name) , understand this is an application for consideration for the upcoming D1 draft for NWBA Division 1 competition. I understand that if selected, and if I choose to play at the D1 level, I will be committed to the D1 team that selects me for a period of two seasons. I also certify to the best of my knowledge that I am physically fit to engage in the activities of wheelchair basketball.

Signed:		Date:
Guardian:		Date:
Emergency Contact:		Phone: