2004 Official Tennis Site Form
2004 Official Tennis Site Form
Contact Name:
__________________________Home Phone: ( ) ____________ Work Phone: ( ) _____________
Fax: (____)____________________________________ E-Mail:______________________________________
Site Name: ______________
Site Address: ____________________
City: __ _______________ State: ___ Zip: _______
Site Phone: ( ) ___________ Fax: ( ) _______
Shipping Address: (if different from above site address):______________________________________________
___________________________________________________________________________________________
City: __ _______________ State: ___ Zip: _______
Type of Site: (Please mark one)
___ Public Park ___ Country Club ___ School ___ Commercial Club
___ Private Court ___ Subdivision ___ College/University ___ Apartment Complex
___ YMCA/YWCA ___ Camp ___ Other:_______________________________
This site is: (Please mark one) ___ a public facility ___ a private facility
Should your site be included in community-wide advertising if available? ___ Yes ___ No
Make area coordinator stipend payable to:______________________________________________________
Send Check To: (if different from above site address)
Address:____________________________________________________________________________________
City: __ _______________ State: ___ Zip: _______
If incentive check is made payable to an individual, that individual’s social security number must be submitted. If the check is made out to an organization, please include the Tax ID number.
Social Security Number or Tax ID Number:_________________________________________________________
Which tennis programs do you offer at this site? (Check all that apply)
___ Instruction ___ USA Team Tennis (Youth) ___ USA Team Tennis (Adult)
___ Collegiate ___ USA League Tennis ___ Tournaments
___ Others: _________________________________________________________________________________
Are you interested in receiving information about USA Tennis programs? (Check all that apply)
___ USA Team Tennis (Youth) ___ USA Team Tennis (Adult) ___ USA League Tennis
Site Director Signature:__________________________________ Date: ______/______/______
Section Coordinator Signature:____________________________ Date: ______/______/______
PLEASE COMPLETE AND RETURN TO:
Attention: Ben Zislis
1331 O’Reilly Drive
Feasterville, PA 19053
(215) 322-6789
