2009 LI-NING PACIFIC RIM OPEN

November 7th & 8th, 2009   USATT FOUR STAR TOURNAMENT

 

 

 

 

Entry deadline is November 4, 2009

 

Name: __________________________________________________ 

 

Address: __________________________________________________________

 

City, State, Zip: ___________________________________________________ 

 

 Phone: __________________________             Birthday _____/_____/____

 

E-Mail Address ___________________________________________

 

USATT Membership No: ____________________ USATT expiration date _____/_____/_____

 

Rating (if known) _______________     Club Affiliation: _______________________ (Needed to avoid first round conflicts.)

 

 

Enter Your Doubles Partner’s Name

 

Open_______________________Mixed___________________________2400________________________

 

3200________________________4000____________________________

 

Events Entered (write event number):  ____, ____, ____, ____, ____, ____, ____, ____, ____, ____, ____, ____

 

Description

Fee

Mandatory USATT Rating Fee

$  7.00

Mandatory Official’s Fee

$  5.00

USATT membership (if required) $40.00 for adult, $20 for youth or $60 for a household

$

Event Fees (add all entry fee for all events)

$

Donations for improved PAC RIM in 2010

$

Total Tournament Fees (thank you)

$

 

Send Entries and Checks To: 

 

Darell Potter/ PTTC

2813 SE Yamhill

Portland , OR 97214

 

Make checks payable to the Portland Table Tennis Club. Entries without checks will not be included in the draws.

 

I will abide by all USATT regulations.  I accept full responsibility for my participation and relieve the sponsors and the USATT from any liability for injury to myself or damage to my property.  If a player is under age 18, their parent or guardian must sign.

 

Signature: _____________________________________   Date: _______________

PLAYERS MUST SIGN THE USATT WAIVER WHEN THEY FIRST CHECK IN!

 RETURN TO PREVIOUS PAGE