NAME:

ADDRESS:

CITY:

STATE:

Zip/Postal Code:

COUNTRY:

Birthdate:

PHONE (Day):

PHONE (Evening):

EMAIL:

Membership Fees: $

Tax Deductible Donation: $

Total Enclosed: $

MC or VISA#:

Expiration:

Cardholder:

Signature:

The undersigned has read the Amateur Athletic Waiver & Release of Liability, with the understanding that they have given up substantial rights by signing below, and do so voluntarily.

Member Signature:

By printing, completing and submitting this form, you have indicated that you:

• have read both the Amateur Athletic Waiver & Release of Liability and the Eyeguard Ruling detailed in part one of the membership application,
• accept all stipulations regarding sanctioned event competition stated therein,
• and will abide by the official rules as set forth by the USRA.

To continue, print and complete the form, then mail to: USRA, 1685 West Uintah, Colorado Springs, CO 80904-2906

New Member

Renewal

Address Change only

Collegiate

High School

International

Domestic Membership
Memberships are for one year and include a subscription to RACQUETBALL magazine. Review benefits.

Adult Membership
-- $30.00/year.

2-year Adult Membership
-- $60.00

Junior Membership
-- $20.00/year. For athletes 18 years of age and younger only.

Junior without magazine
-- $15.00/year. (18 and under only). Without magazine subscription

Lifetime Membership
-- $500.00

International Membership
International membership includes all USRA benefits, plus first-class shipping of RACQUETBALL outside the United States.

International Adult
-- $45.00

International Junior
-- $30.00 For athletes 18 years of age and younger only.

International Junior, without magazine
-- $15.00 (18 and under only). Without magazine subscription