Name (primary new member):

Mailing address (address used by US Postal Service):

City: State: Zip:

Home Telephone: ( ) Work Telephone: ( )

E-Mail:

Sex: [ ] Male [ ] Female

Age: [ ] 19-49 [ ] 50 & up (eligible for adult &/or Senior League)

[ ] 0-18 years: please indicate date of birth:____/____/19____

Are you a member of the United States Tennis Association? ___ yes ___ no

If yes:   NTRP Rating Membership Number Expiration Date

___________ ___________________ ______________

If no:     Please mail USTA information to me!

Membership categories:

[ ] Individual: $10 membership dues

[ ] Family: $15 membership dues for all individuals residing in the same household.

List Additional Family Members (spouse &/or children):

Name             

Sex: [ ] Male [ ] Female    Age: [ ] 19-49 [ ] 50 & up (eligible for adult &/or Senior League)

[ ] 0-18 years: please indicate date of birth:____/____/19____

____________________ [ ] Male [ ] Female [ ] 19-49 [ ] 50 & up [ ] 0-18 / /19

____________________ [ ] Male [ ] Female [ ] 19-49 [ ] 50 & up [ ] 0-18 / /19

____________________ [ ] Male [ ] Female [ ] 19-49 [ ] 50 & up [ ] 0-18 / /19

Please make your check or money order payable to Calvert County Tennis Association. Mail this form, along with your check to CCTA P.O. Box 1353, Solomons, MD 20688. Call 410-326-6763 for more information.