Account Request
Username and Password must contain both letters and numbers
You can not use the same username and password you have used in previous years.


Please complete the form below to receive a Certificate Administrator's login and password on BollingerLAX.com.

Your First Name: 


Your Last Name: 


Phone: (ex: 555-555-5555)


Extension: 










 Organization Name: 


Address:
 

Address 2:
 

City:
 

State:
 


Zip Code:
 



















Select Your User name:


Password:


Password Confirmation: 


Email Address:


Email Address Confirmation:
















I certify that the team or league for whom I am requesting this certificate mandates 100% membership in US Lacrosse, and that I have verified our team/league's roster and all participants are current members of US Lacrosse.

I certify that this is true and I understand that a roster will be required in the event the event of a liability claim in order to confirm membership. I understand that liability claims will only be covered if the team carries 100% membership in US Lacrosse.










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