Membership Application

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ULF Member #

Name*

Mr., Mrs., Ms. First Last Sr., Jr., III

Gender*

Male

Female

Birthday

Current Age

Address*

Street Address Address Line 2 City State ZIP

Primary Email*

Secondary Email

Mailing List

Yes

No

Primary Phone*

Lacrosse Foundation Hall of Fame

Yes

No

Are you a member of Upstate Lacrosse Foundation, Upstate NY Chapter of US Lacrosse Hall of Fame?

Class Year

National Lacrosse Hall of Fame

Yes

No

Class Year

Donation

Yes

No

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