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Athlete Registration

Staff Registration

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Personal Information

First Name: *
Last Name: *
Address: *
City: *
State: *
Zip Code: *
Phone Number: *
Email Address: *
Confirm Email Address: *	Please re-enter your email address to confirm.
Other Contact Information:	A secondary email address or phone number.
Birthday: *
Gender: *	Male Female
Disability: *
Primary Method of Mobility: *

Team

Are you a returning athlete?: *	Yes, I am a returning athlete No, I am a new athlete Have you been previously rostered on any USPSA team?
Team:	Team: *
Additional Roles:	Additional Roles: I am also my team's USPSA Representative I am also my team's Head Coach I am also my team's Assistant Coach I am also my team's Equipment Manager I am also my Team Manager I am also.... If you are also a coach or team rep, indicate so here. You will not need to fill out the staff form.

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