Member Info and League Registration

Member Information & League Registration

2019-2020 Season
First name
Last Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Email Address (for billing)
example@example.com
Email for club communications
example@example.com
PLEASE NOTE: Prices listed are to give you an idea of what your first statement of the season will look like. No payment is necessary now. If you curl with your significant other and would like a combined bill for the both of you, please select a "combined billing" option.
Membership Level
Primary Curling Club
Member you have combined billing with
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent's Name
USA Curling requires that board members and any adult members of the club who have regular contact with athletes who are minors (i.e. Juniors and Little Rocker volunteers) take SafeSport Training.
When did you last take SafeSport Training?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearleave blank if not taken
Leagues you are RETURNING to:
New leagues you would like to ADD:
What team are you curling with on Monday Night?
What team are you curling with on Thursday Night?
Any requests or comments?
shared league spot, preferred position, people you would like to curl with, etc.
Should be Empty:

Member Information & League Registration