Application for Membership

Application for USA National Shuffleboard Association Membership

* Indicates required field

NAME OF STATE *

STATE PRESIDENT CONTACT INFORMATION

State President Name *

First

Last

President Phone Number *

President Email *

President Summer Address *

President Summer City *

Pres Summer State *

President Summer Zip Code *

President Winter Address *

President Winter City *

Pres Winter State *

President Winter Zip Code *

NATIONAL DELEGATE CONTACT INFORMATION

National Delegate Name *

First

Last

Delegate Phone Number *

Delegate Email *

Delegate Summer Address *

Delegate Summer City *

Del Summer State *

Delegate Summer Zip Code *

Delegate Winter Address *

Delegate Winter City *

Del Winter State *

Delegate Winter Zip Code *

SUBMITTED BY

Submitter Name *

Submitter Phone Number *

Submit