2008MembershipWaiverForm

2008MembershipWaiverForm - ULTIMATE PLAYERS ASSOCIATION...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
ULTIMATE PLAYERS ASSOCIATION WAIVER AND RELEASE OF LIABILITY & 2008 MEMBERSHIP APPLICATION UPA – www.upa.org – info@upa.org – 1-800-872-4384 Complete renewal form and waiver and return to UPA, Membership, 4730 Table Mesa Dr., Suite J-200, Boulder, CO 80305. Circle one: Renewal or New Member Circle One: SSN # or UPA ID: ___________________ (may use only last 4 digits of ssn) Name: (Last) ____________________________ (First ) ________________________ Former name: _________________ Address: _____________________________________________________________ Apt/Ste #: ____________________ City/State/Zip/Country: _________________________________________________ Birth Date: ______/______/______ E-Mail: ___________________________________ Phone: (______) ______________________ Circle: Male or Female Check your membership level (Include check or money order made out to the UPA) : $40 Regular $30 College (Half-time student or more. Max 6 yrs.) th birthday before June) $750 Lifetime Membership In addition, I am enclosing a tax deductible contribution in support of Ultimate development $__________.______ Waiver and Release of Liability
Background image of page 1
This is the end of the preview. Sign up to access the rest of the document.
Ask a homework question - tutors are online