Lifetime Membership

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Home Phone (example 555-123-4567): Home Phone (example 555-123-4567) is not valid

Cell Phone (example 555-123-4567): Cell Phone (example 555-123-4567) is not valid

Work Phone (example 555-123-4567): Work Phone (example 555-123-4567) is not valid

Spouse/Partner (First and Last Name): Spouse/Partner (First and Last Name) is not valid

Parent/Guardian: Parent/Guardian is not valid

Email for Spouse/Partner: Email for Spouse/Partner is not valid

Email for Parent/Guardian: Email for Parent/Guardian is not valid

Emergency Contact (First and Last Name):* Emergency Contact (First and Last Name) is Required

Emergency Contact Phone (example 555-123-4567):* Emergency Contact Phone (example 555-123-4567) is Required

Email for Emergency Contact: Email for Emergency Contact is not valid

How did you find the Long Beach Casting Club?: How did you find the Long Beach Casting Club? is not valid

I am under 18 years old (For Junior Memberships, enter Date of Birth below)

Date of Birth for Junior Member (Select mo/day/year on Calendar date picker the click DONE): Date of Birth for Junior Member (Select mo/day/year on Calendar date picker the click DONE) is not valid

For Family Memberships, list Name of Child 1: For Family Memberships, list Name of Child 1 is not valid

Date of Birth for Child 1 (Select mo/day/year on Calendar date picker the click DONE): Date of Birth for Child 1 (Select mo/day/year on Calendar date picker the click DONE) is not valid

For Family Memberships, list Name of Child 2: For Family Memberships, list Name of Child 2 is not valid

Date of Birth for Child 2 (Select mo/day/year on Calendar date picker the click DONE): Date of Birth for Child 2 (Select mo/day/year on Calendar date picker the click DONE) is not valid

For Family Memberships, list Name of Child 3: For Family Memberships, list Name of Child 3 is not valid

Date of Birth for Child 3 (Select mo/day/year on Calendar date picker the click DONE): Date of Birth for Child 3 (Select mo/day/year on Calendar date picker the click DONE) is not valid

I have read the LBCC Waiver and Release Agreement. By clicking the checkbox, you acknowledge that you have read all provisions of this Release, and fully agree to and understand the Release.*

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

No val Please fix the errors above

Pay Long Beach Casting Club

Free

	Lifetime Membership – Payment Free	$0.00
	Total	$0.00

Lifetime Membership – Payment

Free

$0.00

Total

$0.00