ULTIMATE PLAYERS ASSOCIATION WAIVER AND RELEASE OF LIABILITY & 2008 MEMBERSHIP APPLICATION UPA – www.upa.org – firstname.lastname@example.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
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