5 Cities Tennis Association

Annual Membership Application January 1 - December 31, 2017

Name #1:  _______________________________________  Rating:_________

Name #2:  _______________________________________  Rating:_________

Address: _______________________________________

City:         ___________________________ State ____ Zip ______________

Day Phone:____________________ Evening Phone:____________________

E-mail:    _______________________________________________________

I want to be listed on the "Players Looking for Opponents" public section of the website:  Yes  No


If  YES  please Circle One of the following:

Name #1     Will Play                               Name #2     Will Play
     Singles:    Yes      No                                Singles:    Yes      No

     Doubles:  Yes      No                                Doubles:  Yes      No
I have a partner  I need a partner       I have a partner  I need a partner

     Mixed:      Yes     No                                 Mixed:     Yes      No
I have a partner  I need a partner       I have a partner  I need a partner

I authorize Five Cities Tennis Assoc. to publish/distribute my name/phone# to all members.

Signed _________________________________     Date __________

Signed _________________________________     Date __________

Enclosed is a check for membership [$25.00]:                 $__________
I want a Light Key [$25.00]:                                               $__________
[
Contact Ron Pellegrini for a key at 805-474-4756]
                                           TOTAL ENCLOSED:               $__________
Five Cities Tennis Association
1510 Paloma Place
Arroyo Grande, CA
93420