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Click the "Print" button on your browser to send this form to your printer; then MAIL to: West Coast Tennis, P.O. Box 1527, Hermosa Beach, CA 90254; or FAX (credit card payments only) to: (310) 798-0333. Make checks payable to West Coast Tennis. Payment in full due by September 15, 2003. |
| Name _______________________________________________________ | |
| USTA # ______________________________________________________ | |
| Address _____________________________________________________ | |
| City _______________________________ State ______ Zip ___________ | |
| Home Phone ________________________ Work Phone _______________________ | |
| Email Address _________________________________________________________ | |
| USTA Number _________________________________________________________ | |
I apply for entry in the following Men's Singles event(s) (limited to two): |
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| Level: Open_____ 5.5_____ 4.5_____ 4.0_____ 3.5_____ 3.0 (D) ____ Beginner ____ Jr. 10_____ Jr. 12_____ Jr. 14_____ Jr. 16_____ Jr. 18_____ |
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| Seeding Information _________________________________________________________ | |
Credit Card Information ($30.00 for Open and/or $25.00 for NTRP/Jr. will be charged to your credit card) |
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| Credit Card Type ____ Visa ____ MasterCard | |
| Card # ____________________________ Expiration Date (MM/YY): ____/____ | |
| Name as it appears on card: ________________________________________ | |
| Signature: _______________________________________________________ | |