GameDay Credential Form Complete this form and click the SUBMIT button at the bottom of the page. Mandatory fields are designated by the RED asterisk. First Name * Last Name * Street Address * City * State * Zip Code * Phone * Email Optional Race * - Select -BlackWhiteAmerican_IndianAlaskan_NativeAsian/Pacific_IslanderOther Sex * - Select -MaleFemale Last Four SSN * Last four of your Social Security Number Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Age * - Select -Adult: 17 yoa or greaterMinor: 16 yoa or younger Gameday Position * - Select -Security ServicesConcessions VolunteerFirst Aid VolunteerUsher VolunteerVendor StaffMedia StaffOther VolunteerOther StaffCajundome Staff Gameday Affiliation / Responsible Party * - Select -Security ServicesLP Sheriff's OfficeHigh SchoolsOther Non-ProfitCajundome Government Issued ID Type * - Select -Driver's LicenseIdentification CardPassport Issued ID Origin * Type the State that issued the Government ID Passport, Country of Origin Fill this field only if the "Government Issued ID Type" is a Passport ID # Enter the ID # of the Government Issued ID Are you a legal US resident? * YesNo Have you ever been convicted of a felony? * - Select -NoYes Are you a fugitive from justice? * - Select -NoYes Hold Harmless of Indemnification Affidavit * AgreeDisagree I agree to hold harmless and indemnify the State of Louisiana, University of Louisiana at Lafayette, and any of its agents or employees, and any peace officer within this state, from and against any and all liability, claims, actions, fines or losses of any kind or nature, including costs and attorney's fees, in any way arising out of, connected with or related to the approval or disapproval of my access to UL events through the processes of this application. Affidavit of Fact * AgreeDisagree I have read the foregoing application and reviewed the answers and selections which I certify to be true and correct as submitted. In addition, I have also read, understand, and agree to comply with the administrative regulations related to my capacity and access to UL event privileges. Leave this field blank
