Gold Membership Application

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

UPA League Operator (If Applicable)

Name the league operator you will be playing with

Legal Full Name*

Payment made by:*

Please name who made the payment

Phone:*

DOB:*

Email*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Skill/Rating in other leagues:

Suggested Speed (Skill Level):*

I understand/agree that any attempt to gain an unfair advantage in league play shall result in the forfeiture of any prize money.*

Agreed

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