SOWLUA Membership 2016
First Name *
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Last Name *
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Street Address *
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City, State *
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Zip Code *
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Phone Numbers
Please list at least one phone number.
Cell Phone
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Home Phone
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Work Phone
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Email Address *
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Secondary Email Address
Optional
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Birth Date *
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US Lacrosse Membership Number *
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Current Umpire Rating *
See SOWLUA website for current rating
Affiliation *
Please indicate any connection you may have to a school as one of the following:
Required
School
Please indicate the school with which you have an affiliation
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