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CUGA Non-Member Registration Form



CUGA Non-Member Registrants

Please fill out the following information below to become a Non-Member Registrant with CUGA. The information collected allows us to track Underwater Hockey and Underwater Rugby players that wish to maintain an informal connection to CUGA without paying any costs or receiving any benefits.

Registrants can choose to upgrade their affiliation at a later date if they choose by joining CUGA as a full member by paying the membership fee and filling out the CUGA membership form. Details are available on our website at http://www.cuga.org



First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Parent or Guardian's Email Address
Email*
Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Please select which sport your primarily play*
Please choose which city / club you primarily play with on a regular basis and is considered your Home Club. If your Home Club is not listed choose Other from the dropdown and then fill in the text box with your club name.*
Please fill in this box ONLY if your club is not listed in the dropdown choices above.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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