2017 National Team Trials Entry Form
PART I: GENERAL INFORMATION
PLAYER NAME
EMAIL ADDRESS
HOME ADDRESS
PHONE NUMBER
CITY
STATE
USATT ID
EXPIRATION*
CURRENT RATING
ZIP
T-SHIRT SIZE (US SIZES)
DATE OF BIRTH
HOME CLUB
PART II: HOTELS AND HOSPITALITY
ROOMMATE (IF APPLICABLE)
ROOM TYPE
Single
Double
$99/night plus tax pp
CHECK-IN DATE
None
$59/night plus tax pp
CHECK-OUT DATE
NIGHTS
SPECIAL REQUESTS
PART III: COACHES, CREDENTIALS, AND TOURNAMENT PASSES
I would like to request a credential for my coach
Name
I would like to request a credential for my parent/guardian
Name
I would like purchase additional All-Sessions Passes
No.
USATT ID
@ $20/each = $
PART IV: FLIGHT INFORMATION
PLAYER
COACH
ARRIVAL DATE
AIRLINE
FLIGHT NUMBER
TIME
DEPARTURE DATE
AIRLINE
FLIGHT NUMBER
TIME
ARRIVAL DATE
AIRLINE
FLIGHT NUMBER
TIME
DEPARTURE DATE
AIRLINE
FLIGHT NUMBER
TIME
PART V: PAYMENT
PAYMENT TYPE:
MASTERCARD
VISA
CARD NUMBER
AMERICAN EXPRESS
EXP
CID
DISCOVER
CHECK
CASH
NAME ON CARD
PART VI: ACKNOWLEDGEMENT
By signing below, I acknowledge that I read and understand the Trials Prospectus and Trials Procedures.
Participant
Date
Parent/Guardian (if participant is under 18)
Date
COMPLETE ENTRIES MUST BE RECEIVED BY 5PM (MT) ON FRIDAY, MARCH 3, 2017
PLEASE MAKE CHECKS PAYABLE TO USA TABLE TENNIS
VIA US MAIL OR EXPRESS MAIL:
Andrew Horn
USA Table Tennis
4065 Sinton Road, Suite 120
Colorado Springs, CO 80907
ELECTRONIC ENTRY:
Email – [email protected]
Fax - (719) 632-6071
No phone entries will be accepted
*All participants must meet eligibility requirements. To renew your membership, please contact Jon Taylor ([email protected] or 719-8664583, x. 3). On-site membership renewal and Tournament passes will not be available. Proof of citizenship is required.