BRAINERD LAKES CURLING ASSOCIATION

INDIVIDUAL REGISTRATION

***** Return to: *****

Craig O’Reilly

2908 16th Ave. SW

Pine River, MN 56474

218-838-2539

Name: ______________________________________________________________________

Address: ______________________________________________________________________

Home Phone: Cell #: __________________________________

E-mail Address: ____________________________________________________________________

TYPE OF MEMBERSHIP: DUES AMT PAID

G PRIMARY MEMBERSHIP* . ..................................................................... $150.00 $_________

G JUNIOR MEMBERSHIP* (includes Saturday open curling). ....................... $50.00 $_________

G ADDITIONAL LEAGUE*............................................................................. $50.00 $_________

G SUBSTITUTE. ............................................................................................... $50.00 $_________

TOTAL:** $_________

I am playing on team (team name or skip): _______________________________________________

I would like BLCA to place me on a team _____ YES _____ NO

I am willing to skip for a new team _____ YES _____ NO

* Add $25.00 if paid after January 31, 2012.

**Make checks payable to Brainerd Curling League or BLCA

IF DUES NOT PAID BY FIRST DAY OF LEAGUE PLAY,

PLAYER WILL NOT BE ABLE TO PLAY.

I AGREE TO ABIDE BY THE RULES AND BYLAWS OF THE BRAINERD LAKES CURLING

ASSOCIATION (BLCA).

DATE: _____________________ SIGNATURE: ________________________________

CONTACT US:

website: www.brainerdcurling.org

e-mail: brainerdlakescurling@gmail.com

Facebook: Brainerd Lakes Curling Association

Revised 11-28-11