SUMMER TENNIS REGISTRATION
FOR SUMMER 2010 ONLY

Name:____________________________________
If 17 or younger: Boy____  Girl____   Age:____  D.O.B______________

Street address________________________________________________

City, State, Zip________________________________________________

Phone:_____________________(home)  _____________________(cell/work)

E-Mail address: _________________________________________

Level: ____Beginner  ____Low Intermediate   ____Intermediate  ____Advanced

Program Name:________________________________________________

Session Number: ______________Time_____________________ (1st Choice)
Session Number:  _____________ Time_____________________ (2nd Choice)
Session Number: _______________Time____________________  (3rd Choice)
Signature: ________________________________________
Program spots will be lost if registration payment is not received by June 14, 2010.
Parent/legal guardian signature required for applicants under 18 years of age, allowing participation and waiving any claims that may result from injury as a result of tennis activity. Every effort will be made to accommodate all requested program schedules, however all classes must have sufficient enrollment to run. Sorry, no make up classes will be offered.

PAYMENT INFORMATION
Payment method: ____Check enclosed(Made payable to The Racquets Club of Warren)
 ____VISA ____MasterCard
Amount of payment (Payment in full is required for registration. $_____________
Name as it appears on credit card ______________________________________
Credit card billing address___________________________________________
________________________________________________________________
Card number _____________________________________________________
Exp date: _____/_____ CVV/CVC*_____________
*This number is the three digits printed in the signature area on the back of your card.
Card holder signature: ______________________________________________