Midland Curling Club - CB Registration

Required field

First Name

Last Name

Username

Password

Gender

Occupation

Age Range

Address

Address 2

City

Zip Code / Postal Code

Country

State / Province

Home Phone

Cell Phone

Work Phone

Work Extension

Emergency Contact Name

Emergency Contact Relation

Emergency Contact Phone #1:

Emergency Contact Phone #2:

Skill Level

# of Years Curled

Referred to the Club by

Locker Shared With?

Member Since

Full Time Student?

Required field

474 KING STREET BOX 604,
MIDLAND, ON L4R 4L3
705-526-5631
[email protected]