New Account SetupUsernamePassword Enter Password Confirm Password Strength indicator User InformationName(Required) First Last Phone(Required)Email(Required) Date of Birth(Required)MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SexMaleFemalePrefer not to AnswerThis field is hidden when viewing the formAgeUsed to automatically apply the junior discount (if under 21)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Membership InformationMembership Category(Required)PremierBasicPay-as-you-goSocial MemberYear You Started Curling(Required)Have you taken a Learn to Curl with us or elsewhere or curled before?(Required) Yes No List me in the Directory(Required) Yes No This field is hidden when viewing the formPremier Membership Monthly RateThis field is hidden when viewing the formBasic Membership Monthly RateThis field is hidden when viewing the formSocial Membership Monthly RateThis field is hidden when viewing the formCurrent Date MM slash DD slash YYYY This field is hidden when viewing the formFirst Day of Sept. re-starts the pro-ration. MM slash DD slash YYYY The year is irrelevant because we subtract that laterThis field is hidden when viewing the formYears to subtract for Pro-rateTo be used for prorationThis field is hidden when viewing the formMonths for Pro-rateTo be used for prorationWaiver Name Signature Actions Edit Delete There are no Waivers. Add Waiver Maximum number of waivers reached. Fees and DiscountsPay-up-Front Fee Price: $0.00 Junior Curler Discount (Under 21 Years Old) $0.00 Senior Curler Discount (65 Years or Older) $0.00 This registration is for an additional Family Member Yes No Please Select an Already Registered MemberAaron RichterabuczkiewiczadachappAdam MelcherAdam SchroederAdele Langloisaggiez98Alex WilliamsonAlexander GuydoshAlison PrestonAlyssa RoetheliAmanda BartellAnders PorterAndrew DuncanAndrew RussellAnthony MartinezApril McCormackArnieAshley Ryanawleasebarnhardtmichael@gmail.comBen HoppeBenjamin KalkBenjamin OzimekBraxton MealeyBrent SchwanBrett MitchelsonBrian BarkerBrian OzimekBruce StringerBryan HeersemaBuck KrawczykCaitlin RoetheliCammie RiderCarl BellerCatherine CavallarioCharles MooreChelsea CarrckuceraColin BowmanColin KoppenDaniel SuttonDarin HenleyDave DanenfelzerDavid FranklinDawn K BriaDeidra FordDennis Pobelovdennis_dunnDevyn Tonedylanlawrence83Ed WiltsEmily HuffmanEmily WimberlyEric BroekhuisfreepizzaGary NewgordGeorge McCormackGregory GottsackerHatti HartmanHazel BestHeather SmithHeth OwenHoward ElandJacob MooreJames GolabJames HicksJames PutnamJason DixonJed KriegerJeffrey OuelletteJenny LoehlinJeremy ShullJoe Glaeserjoey_chenJohn AlgoodJohn SprangerJohn VeselJon ChristoffersenJon RacinskasJonathan LeeJoshua BallyJumie YuventiJustin CurlessKaren BallingerKelly Bahe NewgordKenneth PoklitarKevin BaughmankurtlyellKyle AndermanLandon CumminsLandon RussellLarry PowellLaura PennickLindsey SchmidtLisa CalderljscheibleMark GardnerMartin HebdaMatt GriffithMatthew CortisMatthew DelaneyMatthew FrancisMichael SimpsonMichael Wenholdmichele_aparicioMidori TanakaNicole HolmOdin NewgordPar Gandhipat_popovichphoebe_haganQuinn Hoinoskirebecca_shoopRichard OchoaRobert GuydoshRobert WoodRyan MaasRyan VanderlipSam JohnsSam RiderSamanthaSamantha Schweigersandman8962Scott McCaskillscott smylieShari BrownShelley HendershotSimeon FordSteve OwenSue BrickerSusan ItoTerri HammonsThomas PronskeTim DeanTim LoomisTracy WhitetreverdesautelTywdlawrence73Will BestWilliam AnastassiouZac GranthamAdditional Family Member Discount $0.00 Payment InformationCoupon Payment Method(Required)Pay Online (PayPal)Pay OfflineThis field is hidden when viewing the formPayment Status (LSCC Use)PaidUnpaidPayPal Fee $0.00 Total Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name This field is hidden when viewing the formIs Active CurlerThis field is hidden when viewing the formHome Curling ClubThis field is hidden when viewing the formYear at Home Curling ClubNameThis field is for validation purposes and should be left unchanged.
