Entry Form - Tabloid EMAIL 2013 UTI - Rockford Table Tennis Club

AMERICA’S TEAM CHAMPIONSHIP
May 25-26, 2013
Forest City Tennis Center
7801 East State St, Rockford, IL 61108
Sponsored by Robo-Pong, Butterfly, Rockford Table Tennis Club,
Landmark Billing Systems, Rockford Convention and Visitors
Bureau, Forest City Tennis Ctr & Clock Tower Resort
A 4-Star Event Sanctioned by USATT
Entry Deadline:
All Entries must be received by Friday, May
10, 2013; Late entries accepted on space
available basis; 42 team limit
Team Name (20 characters or less):
City, State or Club Your Team Represents:
Send Completed Entries To:
Rockford Table Tennis Club
1711 Warren Road
Rockford, IL 61108
Register On-Line At:
www.rockfordttc.com
Mailing Address:
Phone Number:
Email Address:
Team Captain Name:
Player 2 Name:
Player 3 Name:
City/State/ZIP
City/State/ZIP
City/State/ZIP
Membership Number:
Membership Number:
Membership Number:
Membership Expiration:
Membership Expiration:
Membership Expiration:
USATT Rating:
USATT Rating:
USATT Rating:
Player 4 Name:
City/State/ZIP
Membership Number:
Player 5 Name:
City/State/ZIP
Membership Number:
*If any team member is not currently a
USATT member, he or she may purchase
one. Please fill in that player’s address
information in the member number and
expiration fields. Please provide estimated
rating if possible.
Membership Expiration:
USATT Rating:
Membership Expiration:
USATT Rating:
USATT Membership Fees:
Youth - $25/year
Adult - $49/year
Team Entry Fee - $540; plus $10 per person USATT processing fee and tournament registration fee $
USATT Membership Fees (Place Star Next to Players Purchasing Memberships): Adult - $49 per player $
USATT Membership Fees (Place Check Mark Next to Players Purchasing Memberships): Youth/College - $25 per
player
$
Total (Make Checks Payable to RTTC): $
Shirt Sizes:
Player 1: ___S ___M ___L ___XL ___XXL
Player 2: ___S ___M ___L ___XL ___XXL
Player 3: ___S ___M ___L ___XL ___XXL
Player 4: ___S ___M ___L ___XL ___XXL
Player 5: ___S ___M ___L ___XL ___XXL
We agree to abide by all USATT and ITTF regulations and the
decisions of the tournament committee. We accept full responsibility
for our participation and relieve all associated parties of any liabilities
resulting from injury to ourselves or damage to our property.
Captain’s Signature:
Check it out at: www.rockfordttc.com
(Adult/Guardian for Minor) ________________________________________