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
Use same email for club communications?
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*

Men's Full Membership $200 + $49 (USCA, GNCC dues)Men's Full Membership, combined billing $200 + $45 (USCA, GNCC dues)Men's Full Membership, secondary club $200 + $19 (USCA, GNCC dues)Men's Young Adult (under 25) $130 + $49 (USCA, GNCC dues)Men's Social Member $40 + $19 (USCA, GNCC dues)Women's Full Membership $200 + $56 (USCA, GNCC, USWCA dues)Women's Full Membership, combined billing $200 + $52 (USCA, GNCC, USWCA dues)Women's Full Membership, secondary club $200 + $26 (USCA, GNCC, USWCA dues)Women's Young Adult (under 25) $130 + $56 (USCA, GNCC, USWCA dues)Women's Social Member $40 + $26 (USCA, GNCC, USWCA dues)Youth (under 14) parent is Full Member $0 + $9 (USCA, GNCC dues)Youth (under 14) parent is Social Member $40 + $9 (USCA, GNCC dues)Junior (14-21) parent is Full Member $40 + $28 (USCA, GNCC dues)Junior (14-21) parent is Social Member $80 + $28 (USCA, GNCC dues)
Primary Curling Club
Member you have combined billing with
Date of Birth

MonthDayYear
Date
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
leave blank if not taken
Leagues you are RETURNING to:*

Monday Night ($97)Tuesday Morning ($80)Tuesday Night ($97)Wednesday Night ($97)Thursday Morning ($80)Thursday Night ($80)Friday Night ($80)Saturday Night ($80)Sunday Morning ($80)Sunday Night ($97)Mixed Doubles ($80)Not returning to the same league(s)
New leagues you would like to ADD:*

I am NOT adding any new leagues this seasonMonday Night ($97) FULLTuesday Morning ($80)Tuesday Night ($97) FULLWednesday Night ($97) FULLThursday Morning ($80)Thursday Night ($80) FULLFriday Night ($80)Saturday Night ($80)Sunday Morning ($80)Sunday Night ($97) FULLMixed Doubles ($80) FULL
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