Name: Age:

Address (Include Apt #):

City: State: Zip:

Phone Number: Social Security Number:

Email Address:

Have you ever been a member of the PBA ? Yes No * If yes, date joined?
Have you ever been a member of the LPBT? Yes No * If yes, date joined?
Have you ever cashed in a PBA or LPBT Event? Yes No

Are you a Member of ANY other Tournament Clubs or Organizations? Yes No
*Mid-State Masters *Michigan Majors *Other Specify
*Have you ever won a tournament title with any of the above listed organizations? Yes No

All 2008-2009 Year Book Averages : *MUST LIST ALL AVERAGES

All 2007-2008 Year Book Averages :

*Have you had any Tournament winnings over $600 in the previous 12 months? Yes No
*If yes, What tournament and date? __________________________________________________________________________.

*Have you ever been RE-RATED for any tournament event? Yes No

USBC Sanction #: USBC Sanction Card Average:

*Fill out application, print and bring with you to your first tournament.