APA Rochester's Patch Request Form

Congrats on earning a patch! Please fill out the form below and we will mail your patch directly to you.

Captains may request patches for any players on their teams.

**This form is for members of APA Rochester ONLY.
Please contact your League Operator if you play in another area.**

Choose Patch and Quantity

	1	2	3
Rackless
8 BALL Break & Run
8 on the Break
9 BALL Break & Run
9 on the Snap
8-Ball Mini Slam
9-Ball Mini Slam
9-Ball 20-0
8-Ball Team Clean Sweep (One Request will get 5 patches)
9-Ball Team Clean Sweep (One Request will get 5 patches)
100 Matches Played
250 Matches Played
500 Matches Played
1000 Matches Played
750 Matches Played
1500 Matches Played
I Won My First Match (Win 1st APA match ever played)
GRAND SLAM (Both and 8-Ball & 9Ball Mini Slam in same session)
I Beat The League Operator - Amy
I Beat The League Operator - Matt
8 Ball - I Beat a 6 (Must be SL4 or below)
8 Ball - I Beat a 7
8 Ball - I beat an 8
9-Ball I beat a 7 ( Must be SL 5 or below)
9-Ball I beat a 8
9-Ball I beat a 9
Team Captain
Team Co- Captain

Special Requests?

Need more than 3 of one patch or would like to request a pin? Pins are earned after a patch has been earned 3 times in one session. Team Captain pins are earned after 3 consecutive captaining sessions of the same team.

Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code