Individual Registration

Please enter your information in the form below to register for Level 0 Outdoor Umpiring Course - Theory (Online).

First Name *

Last Name *

Email *

Mobile Number *

ID Number *

Date of Birth *

Gender *

Ethnicity *

What town or city do you currently reside in? *

Province *

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If Individual or Group Registrants are under the age of 18, then please upload a signed letter of consent from the parent or legal guardian

Do you require an invoice?

yes

Organization *

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Payment Information

Sub Total (Ex VAT)

15% VAT

Total

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Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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