Register for USPTA's Tennis Across America

Yes, I will participate in USPTA's Tennis Across America as a/an
host professional assistant

Name:
USPTA member Yes No
Member No.:      Division:   
Contact phone: 

e-mail address:

Date of clinic:

My clinic/social will be open to the public members only

This is a multicultural clinic yes no
Type of event
Facility name:
Street address:

City: ZIP:

Country:
Facility phone:
Please include my clinic at playtennis.com  
The following people will assist at my event:

Name: Member No. (if applicable):

Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):
Name: Member No. (if applicable):