PTA Membership Application for 2007
Individual Membership

 
First Name: 
Last Name: 
Address: 
City: 
State: 
Zip: 
Phone: 
Country: 
Date of Birth:(mm/dd/yyyy)
Fill in below for family membership only

 
SPOUSE: 
Birth Date:(m/d/y)
CHILDREN:
Birth Date:(m/d/y)
CHILDREN: 
Birth Date:(m/d/y)
Individual annual membership $35.00
Family annual membership $45.00
Supporting individual annual membership $20.00 (for non players)
Corporate annual membership $100.00
Life membership $500.00 (One time payment)

Enter Your Email Address:

Please submit, print this form and mail it together with check payable to:
PTA,    2511 W. Sunflower # D-6, Santa Ana, CA 92704
I/We hereby waive and release the Polish Tennis Association of Southern California from any and all claim, demands, loss, liability or causes of action, now existing or hereinafter, known or unknown, which may arise in connection with my/our participation in the programs, tournaments, ladders and/or leagues of the Polish Tennis Association of Southern California.

Signatures:
_______________________ / __________________________   ____________________
Applicant Spouse  Date