USA Table Tennis

Please enclose $50 Affiliation Fee.

Recommendation: Cut & Paste the form below to a word-processing program.

Club Name:___________________________________________________________

Playing Site Address*

Name of Building:_____________________________________________________

Address:____________________________________________________________

City, State, Zip:_______________________________________________________

Mailing Address

Correspondent's Name:_________________________________________________

Address:____________________________________________________________

City, State, Zip:_______________________________________________________

Telephone:___________________________________________________________

Club Contact*

Name:______________________________________________________________

Telephone/email:_______________________________________________________

Web Page:___________________________________________________________

*Unless otherwise requested, this is the information which will appear in USATT publications

Club Officers

President:_____________________________________________________________

Telephone:____________________________________________________________

Vice President:_________________________________________________________

Telephone:____________________________________________________________

Secretary:_____________________________________________________________

Telephone:____________________________________________________________

Treasurer:_____________________________________________________________

Telephone:_____________________________________________________________

No. of Club Membership Cards Needed:________________________________________

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