Schenectady Curling Club
Membership Registration for 2018-2019 Season.
NOTE: REQUIRED FIELDS are denoted with asterisk (*)

For additional information, please visit our website http://schenectadycurlingclub.us
or send email to schenectady.curlingclub@gmail.com

Email address *
Indicate your status *
Contact Information
FIrst Name *
Your answer
Last Name *
Your answer
Preferred name (nickname)
Your answer
Gender (for demographic purposes only) *
Birthdate (for demographic purposes only) *
MM
/
DD
/
YYYY
Spouse's Name
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Primary email *
A valid email is required. An email confirming receipt of your membership form will be sent to this address.
Your answer
Secondary email
Your answer
Emergency Contact Name *
Emergency contact information is being collected for all members. Info will be kept on file at the SCC. It will not printed in the membership directory.
Your answer
Emergency Contact Phone Number *
Emergency contact information is being collected for all members. Info will be kept on file at the SCC. It will not printed in the membership directory.
Your answer
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