Membership
First Name: *
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Last Name: *
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DOB: *
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Position: *
High School *
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College: *
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Highest Level of Playing Experience: *
Street Address:
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City:
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State: *
Email: *
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Primary Phone: *
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Secondary Phone: *
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Current Employer:
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Jersey Size:
Short Size:
Jersey #:
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Shoe Size:
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Current Club Affiliation(s):
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Bio:
Please enter a short bio of your player accolades, accomplishments or general public interest items that you would like to make public as a member of the PLA.
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