Individual Registration


Please make sure all required fields (*) are completed correctly

General Information
*  First Name: 
*  Last Name: 
Country:
Canada 
  Address 1:
 
Address 2:
City:
 
Province:
   
  Postal Code:
    
  County:
   
*  Birthdate: 
   
Please enter a phone or an email address.
Email: 
Confirm Email: 
Home Phone: 
()-
Work Phone: 
()-
Alternate Phone: 
()-
Daytime Phone
Gender
Have you ever played in the CPA before?
/
City: 
State/Province: 
Member #: 
Format Played: 
Highest 8-Ball Skill Level: 
Highest 9-Ball Skill Level: 
Have you ever played in a non-CPA pool league?
/
League Name: 
Skill Level (Rank): 
Comments (Optional)
Submit Form