American Water Polo Registration Forms and Payment Information
Fee Summary
Individual Registration Form
Club Registration Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

American Water Polo Individual Membership Form
 (Coaches registering their clubs must use the Club Registration Form)

First Name   MI   Last Name    
Street       
City    State   Zip  
Email       
Primary Ph      Home Work Cell (circle one)
Secondary Phone     Home Work Cell (circle one)
Date of Birth         
Membership Type (check all that apply)
$40 Senior Athlete (23 or older)      $30

Scholastic Athlete
(22 or younger)

   
Free Coach or Referee   $25 Limited*  
$35 Contributor/Parent    $75 Family Plan  
*The Limited Membership is available to athletes currently registered with USWP. Individuals must show proof of membership with their application. This membership does not provide any benefits other than insurance coverage for the competitive events.
If choosing Family Plan, list the names of the additional immediate family members
Name   Date of Birth   Shirt Size  
Name   Date of Birth   Shirt Size  
Name   Date of Birth   Shirt Size  
Name   Date of Birth   Shirt Size  
 
(Please circle one)

Shirt Size: Adult XXL----Adult XL----Adult Lg----Adult Med/Yth XL----Adult Sm/Yth Lg----Yth M----Yth Sm
Club Name      If not affiliated with a club, check the box to the right  
Coaches registering ten or more athletes will be eligible to receive an annual reward. For example, AWP would provide rewards for two coaches in a club with 20 athletes.
Total Amount Enclosed $
Checks should be made payable to American Water Polo and sent to:
AWP, 320 West 5th Street, Bridgeport, PA 19405

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Club Registration Form
This form is to be used by a coach when registering a club team. Each club may field as many age levels
and genders as desired but should only register one time.

Club Name      
Coach      
Address      
City   State   Zip  
Age levels you wish to receive information on for tournaments     
Development (12 & under)    Youth (13-15)  
Junior (16-19)     Senior (any age)  
Masters (list age groups)           
Ball size requested Junior   Women's   Men's  
Fee $35    
Checks should be made payable to American Water Polo and sent to:
AWP, 320 West 5th Street, Bridgeport, PA 19405

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payment Summary

Individual Plans:
Total Cost
Senior Athletes (23 or older)
$40
Athletes registering between September 1st and December 31st
$20
Coaches and Referees
Free
Contributor/Parent
$35
Limited (individuals must show proof of USWP membership with their application)
$20
Scholastic (must be a student under the ageof 23)
$25
Family Plan (for immediate family members only):
Total Cost
Unlimited number of memberships in the same immediate family
$75
Checks should be made payable to American Water Polo and sent to:
AWP, 320 West 5th Street, Bridgeport, PA 19405