InfoSport:

2006 Pro Basketball Combine application

Please print out this page, complete the form, and mail or FAX to InfoSport along with the appropriate fee(s).

PLEASE TYPE OR PRINT

PERSONAL DATA:

Name: _________________________     Date of Birth:__________    Male or Female  (Circle One)

Current Phone (valid until): ____________________  (_____) Permanent Phone: ___________________

Mobile Phone: ____________________

email address: ______________________________

(please make sure this email address is valid and that you have frequent access to it)

Current Mailing address: _________________________________________________

City: _______________ State: _____ Zip: __________ Valid Until: __________

Permanent Mailing address: _______________________________________________

City: _______________ State: _____ Zip: __________

Positions Played (circle all that apply):

1          2          3          4          5

Height: __________ Weight: __________ Size of Jersey (circle one):    M     L     XL    XXL

(we make every attempt to provide you the requested size, but we cannot guarantee it)

Any injuries during your career? (List type, date and result):

Any surgeries?

List any pertinent medical conditions (asthma, diabetes, allergies, etc.)

Are you married? Yes     No     (circle one)

Do you have children? Yes     No     (circle one)     If so, how many? _____

Do you have a passport?

Country of Issue:___________________________

Do you have dual citizenship with another country? If so, which country?

If you are not a US citizen, what is your US residency status?

Please provide the BIRTHPLACE for each of the following:

Yourself: ________________________ Maternal Grandmother: _________________________

Mother: _________________________ Maternal Grandfather: _________________________

Father: _________________________ Paternal Grandmother: ________________________

Paternal Grandfather: _________________________

Agent’s Name: ___________________________________ (leave blank if not represented)

Agent’s Phone: ______________________ Agent’s FAX: ______________________

Agent's email address: _____________________________________________

Agent's web site: www. _________________________________________

Agent’s Address: __________________________________________________

City: __________________ State: _____ Zip: __________

COLLEGE BASKETBALL EXPERIENCE:

College attended: _________________________ Head Coach:  ____________________

Coach's phone number:__________________________________

Coach's email address: _________________________________

Sports Information Director: _______________________________

SID Phone: _______________________

SID email address: __________________________________

Final Season of eligibility: __________

(Participation in this event could impact collegiate eligibility. If you have eligibility remaining, consult with your coach or athletic director.)

College Stats/Honors/Records:

PROFESSIONAL BASKETBALL EXPERIENCE:

Pro Team: _______________ League: ____________________ Year(s) with team: __________

Pro Team: _______________ League: ____________________ Year(s) with team: __________

Additional Information/Comments Regarding Professional Basketball Experience:

COMBINE EVENTS (please indicate for which events you will be registering):

Event/Location / Dates

o WOMEN'S PRO BASKETBALL DEVELOPMENTAL CAMP, Altamonte Springs, FL - Friday, June 2, 2006 ($35)

o WOMEN'S PRO BASKETBALL COMBINE, Altamonte Springs, FL - Sat - Sun., June 3-4, 2006 ($235-postmarked or FAX'D on or before 4/15/06)

o WOMEN'S PRO BASKETBALL COMBINE, Altamonte Springs, FL - Sat- Sun., June 3-4, 2006 ($265-postmarked or FAX'D after 4/15/06)

o MEN'S PRO BASKETBALL DEVELOPMENTAL CAMP, Altamonte Springs, FL - Tuesday, May 30, 2006 ($35)

o MEN'S PRO BASKETBALL COMBINE, Altamonte Springs, FL - Wed.-Thurs., May 31-June 1, 2006 ($235-postmarked or FAX'D on or before 4/15/06)

o MEN'S PRO BASKETBALL COMBINE, Altamonte Springs, FL - Wed.-Thurs.., May 31-June 1, 2006 ($265-postmarked or FAX'D after 4/15/06)

PAYMENT INFORMATION:

Calculate your total:

Combine Fee $235 _____ (postmarked or FAX'D on or before 4/15/06)

Combine Fee $265 (postmarked or FAX'D after 4/15/06)

Developmental Camp $35 _____

Video Fee (includes games at combine, digitally recorded, on VHS tape) $40 _____

Spectator/Guest Pass $3 each _____

TOTAL __________

Select Method of Payment:

o  Certified Check or Money Order enclosed (made payable to InfoSport, Inc.)  NO PERSONAL CHECKS ACCEPTED

o   American Express, Master Card or Visa Card Number: ________________________________________

Card expiration date: ___________________

Name as it appears on card: __________________________________________

Signature: ________________________________________________

Billing Address: __________________________________________________________________________________

(NOTE: Credit card orders will be charged a 5% processing fee, based upon the total bill)

NO PERSONAL CHECKS ACCEPTED

Once a player has registered, been accepted, and their payment has been processed, there are NO REFUNDS.

NO EXCEPTIONS.

Mail your application, registration fee and any supporting materials to:

InfoSport, Inc., P.O. Box 935, Media, PA 19063, USA

FAX 215-689-1479