Membership – Sign-up – Charlotte Curling Association

Membership Form - New Member

New Account Setup

Username(Required)

Password(Required)

Enter Password Confirm Password

Strength indicator

User Information

Name(Required)

First Last

Primary Phone(Required)

Secondary Phone

Email(Required)

Date of Birth(Required)

Sex(Required)

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Age

Address(Required)

Membership Category

Year Started Curling at CCA(Required)

Emergency Contact/Waiver

Emergency Contact Name(Required)

Emergency Contact Primary Phone(Required)

Emergency Contact Secondary Phone

Adult Waiver

Curler's Name	Event Type	Actions

There are no Entries.

Youth Waiver

Name of Minor	Name of Parent or Guardian	Actions

There are no Entries.

Only needed when new member is a youth!

Payment Information

Subtotal

$0.00

Coupon

Total

Payment Method*

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Required but Hidden

Hidden

Secret Code

Code is sent to people who are helping with the website.

Membership ID Number

Hidden

Is Active Curler

Hidden

GNCC Club Number

Hidden

Years at Home Curling Club

Hidden

Home Curling Club

Comments

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