Referral Signup Form

Thank you for your interest in wanting to not only help your community, but also wanting to help us build a better Mississippi. Please fill out the information below.

First name

Last name

Email

Phone

Address

Birthday

Month

Day

Year

Are you affiliated with a specific school?

If yes, what school are you affiliated with?

Please briefly describe yourself. Include where you work, if you have kids, community organizations, degrees, any awards, or anything you want to tell us about yourself.

How would you like your payments sent to you?

Check

Deposit

Cash App

If Deposit Enter Your Routing Number

If Deposit Enter Your Bank Account Number

If Cashapp, enter your cashapp pin

If check, who is the check made payable to?

By checking this box, you agree that all of the information that you have provided above is true to the best of your knowledge. You also agree to the rules and guidelines of the Mississippi Association of Players in terms of participation of this program. You further agree and understand that Mississippi Association of Players reserves the right to deny applications or terminate you from this program at anytime.