Membership Update/Correction

USAPL Membership Update/Correction Form
Complete ONLY the area that need to be updated/corrected on your membership card. (Name, Card # & Email required)
Name*

First NameLast Name
USAPL Membership #*
E-mail*

Confirmation Email
Phone Number:

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date:

MonthDayYear
Age:
Sex:
US Citizen?
Membership Type
Division(s)

OpenMasters (Age 40+)Junior (Age 20-23)Teen (Age 14-19)Youth (Age 8-13)Special OlympianNon-Compete
USAPL Registered Club (If Applicable):
Referee Status (Subject to verification)
Electronic Signature
Signature*
Should be Empty:

USAPL Membership Update/Correction Form