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Please enclose $75 Affiliation Fee and use this form.

Club Affiliation Form

Annual fee …………………………………………….. $75.00

(Multi-year payments will not be accepted)

CLUB NAME:  _______________________________________________________________

Please answer all of the questions completely:

PLAYING SITE ADDRESS (be complete):*

(Any additional playing sites may be listed on page 2)

Name of Building:          _________________________________________________________

Address:                          _________________________________________________________

City/State/Zip Code        _________________________________________________________

What are the Club hours of operation: * _____________________________________________

_____________________________________________________________________________

CLUB MAILING ADDRESS (if different from playing site):

Correspondent’s Name:   _________________________________________________________

Address:                        _________________________________________________________

City/State/Zip Code:       _________________________________________________________

Telephone No:  (Home)   ________________________ (Work) __________________________

Email Address(required):_________________________________________________________

                            

CLUB CONTACT:* 

Name:                         __________________________________________________________

Telephone No:  (Home) _________________________ (Work) __________________________

Email Address(required)__________________________________________________________

Club Website:              __________________________________________________________

CLUB OFFICERS:

President:                    __________________________________________________________

Telephone No.              __________________________________________________________

Email Address:             __________________________________________________________

Vice President:            ___________________________________________________________

Telephone No.             ___________________________________________________________

Email Address:            ___________________________________________________________

Secretary:                     __________________________________________________________

Telephone No.              __________________________________________________________

Email Address:             __________________________________________________________

Treasurer:                     __________________________________________________________

Telephone No.             __________________________________________________________

Email Address:             __________________________________________________________

Does the club have a membership structure?  Yes ______   No _______

If yes, please describe (For example, does the club maintain a membership list?  Are membership fees monthly, annual? What are the membership fees?):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

If yes, how many members does the club currently have?  _______________________________

How many tables does your club use when open for play? _______________________________

What programs does your club offer/provide? (For example: Leagues, Coaching, Tournaments, Open Play, Junior Program) _______________________________________________________________________________

_______________________________________________________________________________

Does the club have a bank account?   Yes ________   No _________

Additional Multiple Location Information

PLAYING SITE ADDRESS (be complete):*

Name of Building:          _________________________________________________________

Address:                          _________________________________________________________

City/State/Zip Code        _________________________________________________________

What are the Club hours of operation: * _____________________________________________

_____________________________________________________________________________

*Unless otherwise requested, this information will appear in USATT publications.

Please return completed form to the following address:

 

USA Table Tennis

Attn: Membership Director

4065 Sinton Rd.  Ste. 120

Colorado Springs, CO 80907

Telephone #: 719-866-4583 X5

Fax #: 719-632-6071