Dues:  $10 to PACS /$10 Processing Fee:  Total Due $20.00

Name (as it appears on Drivers License): _________________________________________

Street Address:  _____________________________________________________________

City:  _______________________________  State:  ____________  Zip:  _______________

E-mail:  ____________________________________________________________________

Home Telephone:  __________________________  Cell:  ___________________________

League currently participating in:  ______________________________________________

League Representative:  ______________________________________________________

By agreeing to participate in the PACS league events and activities, or competition situation, the participant agrees to grant PACS the sole right and discretion to restrict,

remove, or disqualify any player for any reason related to safety, personal conduct, or behavior considered detrimental to the PACS. All players agree to indemnify and

hold harmless the Pacific American CueSports Alliance (PACS), its officers, directors, league operators, representatives, host site, or any affiliate organization for any        

personal injury and/or death, and/or property damage, and/or any other liability arising out of, or in conjunction with the participants while competing, attending, or while

travelling to and/or from any PACS sponsored events.

Player’s Signature:  ___________________________________  Date:  _________________


MEMBERSHIP BENEFITS:  Benefits are based on 8 qualified weeks of league in at least one session of play.

Eligible to qualify and compete in the PACS Regional 8-ball & 9-ball championships. This will not qualify you for the ACS Nationals.



PACS Representative Verification:  ______________________________________________

Amount Received by PACS Representative:  $_______   Date:  _______________________


             Mail to:  Judy Griffith, 1016 SE 132nd Ave, Vancouver, WA 98683

                  Email:  shordunski@aol.com