Referring Member's Name or Player Number?

Old Division/Team or Team Name (If Applicable)?

New Team Name:*

Which night of week will your team play?*

Host Location:*

Street Name:

City:*

State/Province:*

Zip/Postal Code:

Telephone:

No. Of Pool Tables?*

Captain's Name:*

CPA PLAYER #:

New to the CPA?

Date Of Birth:

Email:

Home Phone:

 Work  /Cell #:

PLAYER NAME

PLAYER #

NEW

Co-Captain:*

Player #3:*

Player #4:

Player #5:

Player #6:

Player #7:

Player #8: