X/TwitterThis field is for validation purposes and should be left unchanged.New Account SetupUsernamePassword Enter Password Confirm Password Strength indicator User InformationName(Required) First Last Phone(Required)Email(Required) Date of Birth(Required)MMMM123456789101112DDDD12345678910111213141516171819202122232425262728293031YYYYYYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SexMaleFemalePrefer 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 prorationWould you be willing to occasionally make an additional donation to the club to sponsor a curler who otherwise may not be able to play? Yes No If you select yes we'll only contact you when a situation occurs. WaiverPlease click Add Waiver below to review the waiver and submit your acknowledgment Name Signature Actions Edit Delete There are no Waivers. Add Waiver Maximum number of waivers reached. Code of Conduct AcknowledgmentPlease click Add Entry below to review the club Code of Conduct and submit your acknowledgment Name Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. DisclaimerFees 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 Langloisaggiez98Aidan MitchelsonAislinn KellingAlex WilliamsonAlexander GuydoshAlison PrestonAllen OleniakAlyssa RoetheliAmanda BartellAnders PorterAndrew DuncanAndrew RussellAnna OliverAnthony MartinezApril McCormackArnieAshley McColloughAshley RyanasuttiekAustin CargolAustin DeMossawleasebarnhardtmichael@gmail.comBen HoppeBenjamin KalkBenjamin OzimekBrady BakerBraxton MealeyBrent SchwanBrett BeelerBrett MitchelsonBrian BarkerBrian BlonsteinBrian MeyerBrian OzimekBrimm WalkerBruce StringerBryan HeersemaBryan McCauleyBuck KrawczykCaitlin RoetheliCameron BroussardCammie RiderCarl BellerCarrie CaroselliCatherine CavallarioCavan MerskiChantal MiklosiCharles MooreChase MitchelsonChelsea CarrckuceraClare BiedermanColin BowmanColin KoppenConor MagillDaniel SuttonDanny BrauckmanDarin HenleyDave ArcherDave DanenfelzerDavid FranklinDavid UihleinDawn K BriaDawson WarnkenDeidra FordDennis DunnDennis PobelovDerek ByzinskiDevon McColloughDevynDilan Gandhidjpjsparklesdylanlawrence83Ed WiltsElliot SchroederElliott RichterEmily HuffmanEmily WimberlyEric BroekhuisEric Tarziaericharris435freepizzaGary NewgordGeorge McCormackGrant MelsongravitywizGregory DisherGregory GottsackerHakimi FirouzeHatti HartmanHazel BestHeather SmithHenry UlrichHeth Owenhoconnor76Howard ElandJack MillerJacob MooreJames GolabJames HicksJames PutnamJason DixonJed KriegerJeffrey OuelletteJennifer CaudleJennifer ZamoraJenny DrakeJenny LoehlinJeremy SchwenkJeremy ShullJoe Glaeserjoey_chenJohn HallamJohn SprangerJohn VeselJohn WalkerJohnny AlgoodJohnny HendershotJon ChristoffersenJon RacinskasJonathan LeeJoon-Yee ChuahJosh PetersonJoshua BallyJumie YuventiJustin CooperJustin CurlessKaren BallingerKati SteckerKeith KamerKelly Bahe NewgordKenneth PoklitarKevin BaughmankurtlyellKyle AndermanLally GomezLandon CumminsLandon RussellLarry PowellLaura BealLaura PennickLinda ScheibleLindsey BatesLindsey SchmidtLisa CalderMarcela Tamez HernandezMario ContiMark GardnerMark LangsethMarlo NewgordMartin BraisMartin HebdaMathew CostelloMatt GriffithMatt HammonsMatthew CortisMatthew DelaneyMatthew FrancisMatthew KellingMeng ChenMichael SimpsonMichael WenholdMichele AparicioMichelle BruceMidori TanakaMikko SojonenMitun RankaMorgan GreenNat LombardoNathan JessenNathan PalanovNathaniel LafleyNeal KrajnikNicholai BenkoNicole HolmnwellinghoffOdin NewgordPar Gandhipat_popovichphoebe_haganQuinn HoinoskiRachel GuyetteRebecca ShoopRichard OchoaRobert GuydoshRobert HendershotRobert WoodRyan BatesRyan MaasRyan VanderlipSam JohnsSam OrtegaSam RiderSamanthaSamantha Schweigersandman8962sarahsnyder_33Scott CaudleScott McCaskillScott SmylieScott WardShamik JaniShannon ZoellerShari BrownShelley HendershotShravik SethiSim FordSimeon FordStacey VirdellSteve OwenSue BrickerSusan ItoTerri HammonsTEST USERThomas GoddenThomas PronskeTim DeanTim Loomistisha_kerseyTommy LeeTraci McColloughTracie ChanTracy WhitetreverdesautelTrevor EvensonTrina PattersonTyvalurgVanessa DiamosVictoria Levasseurvictoriaozimekwdlawrence73Will BestWilliam AnastassiouZac GranthamZula WhitmerAdditional 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 Club
