UPA Membership Application Form

UPA Membership Application

To apply for membership please complete all questions.
Choose your membership:

Gold Member $25Touring Pro $150
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Cellular Number
Gender:

MaleFemale
Date of Birth:

MonthDayYear
Date
How many years have you played pool?

Never1-34-67+ years
What is your rank/rating in other leagues?
Name of League
Rank/Skill level
IF SIGNING UP A TEAM Each Player : Type Name, Current Rank in any other league (if any), Phone Number, Date of Birth, and email address.
What is the proposed team name?
What bar will you be playing out of and what night?
Will this be 8-Ball or 9-Ball?
Please use below cashapp link to pay your membership fee. If you are signing up an entire team, please make sure you pay $10 for each member signing up.

**NOTE - if you are on a mobile device and can't scan the below QR code, you can manually type in the cash tag $tristateupa into Cashapp to pull up the correct person to pay. If you do not have Cashapp we will message you with other options to pay your membership dues.**
It is my personal responsibility to know and follow all UPA Rules, Policies and Procedures. I shall conduct myself in a manner consistent with UPA ideals and will work to represent the UPA in a professional and courteous manner. I accept that any attempt to gain unfair competitive advantage(s) subjects me and my team to dismissal from UPA Events, forfeiture of membership and prize money. I agree to indemnify and hold harmless the UPA, its licensees, directors, and personnel for any personal injury and/or any other liability rising out of competing in any UPA events.
Signature

Clear
Signature Date

MonthDayYear
Date
Should be Empty: