You must provide your Legal name.

First ________________________________________________________________________________

Middle Initial _____

Last ________________________________________________________________________________

Street Address________________________________________________________________________

City _________________________________________________________________________________

State _________________________ Zip ______________________  Country  ______________________

Home Phone _____________________________     Work Phone _________________________________

Date of Birth (MM/DD/YYYY)    _____/_____/________                        Gender  Male __  Female __

Email Address _________________________________________________

Do you have Health & Accident Insurance?   Yes  __ NO __ 

Sport Code (circle one)      BA  (Boys Basketball)      BW  (Boys Basketball)      BL  (Baseball) 

Club Name (if known) _______________________________________________________________

Club Number (if known) _______________________________________

Primary Program __ Youth Program (ages 1-20)

Youth Program consists of athletic participation for ages as defined by AAU Youth sport rules. Basic Youth ages are 1 to 20.
Youth Membership allows participation/coverage in any and all youth sports.              

By authorizing payment of my annual membership dues, I certify that this application is correct in every material
aspect, including but not limited to my (street) address and birth date.  The Applicant agrees to be bound the AAU Code, including all
AAU Policies, which are available for review on the AAU Web site at www.aausports.org.
Note: Parent/Guardian signature if member is under 18 yrs old.

__________________________  ___________    _________________________  _____________
Member's Signature                         Date                    Parent/Guardian Signature              Date

AAU Membership Year is September 1 to August 31
Youth Membership:   Regular Membership $12.00   Added Benefit:  Membership $14.00