Ursamen Registration
Each member needs to register individually, but dues can be paid for multiple memberships.
First Name *
Your answer
Last Name *
Your answer
Name as you'd like it to appear on your nametag *
Your answer
Email *
Your answer
Phone Number (no dots or dashes)
Your answer
Birthday *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Can we contact you? *
Are you OK with having your photos taken at Club events to be posted in the website? *
How are you paying for your membership dues? *
By clicking on the Submit button below, you are agreeing to abide to the Bylaws of the Northeast Ursamen (available upon request), and attest to being over 21 years of age.
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