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BC Soccer Referees Association > Pages > AddMembership

 Membership form - all fields with * are required

 

First Name *


Last Name *


Home Phone


Please format with dashes: 604-555-5555

Mobile Phone


Please format with dashes: Please format with dashes: 604-555-5555

Email *


Address *


City *


Province *


Postal Code *


Please format correctly: V0N 1V3

Age 18 or under?


Tick this box only if you are 18 years of age or younger as of today.

Membership Year *



Soccer Area *


Pick the area that best represents where you are located.
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