2008 USPTA High School Coach Workshop registration form

Friday, Sept. 19
La Quinta Resort and Club, La Quinta, Calif.

Please register by Sept. 5 to reserve your course materials.

Main registrant
First name:
Last name:
Address:
Address 2:
City:
State:
ZIP:
Country:
USPTA member No.: 
Division:
Nonmember:
e-mail:
Home phone:
Work phone:
If you are interested in testing or upgrading, please check here.

 

Fees
 
High school coach
$50
   
Subtotal 1    

Total fees
Subtotal 1
Grand total

Payment options

Check here if credit card billing address is the same as the address above. If different, fill in the address information below.

First name:
Last name:
Cardholder address:
City:
State:
ZIP:
Country:
Credit card:
Card No.:
Expiration date:
Security code*:
Signature:  
*How to find your security code:
Visa and MasterCard – On the back of your card, locate the final 3-digit number.
American Express – On the front of your card, locate the 4-digit number on the top right corner.

This is a secure form. However, if you would prefer to mail in your form, send it to
USPTA, 3535 Briarpark Drive, Suite One, Houston, TX  77042, or fax to 713-358-7785.