USTA Georgia
Standard Tournament Entry Form

This entry blank may be printed out and used for entry into USTA Georgia sanctioned adult events or junior events. Entry to all tournaments requires proof of current USTA membership.

Tournament Name: ________________________________________________

Tournament Dates: _______________

Player's Name: ___________________________________________________

USTA #: __________________________ Expiration Date: ________________

Address: ________________________________________________________

City: ________________________ State: _______ Zip: _________________

Phones (H) _______________________ (O)___________________________

Date of Birth: __________________    Email address: ___________________

Current Rankings: (State )________ (Sectional) ________ (National) _______

Credit Card (Type) # ____________________________ Exp. Date: ________

Total Amount Enclosed or Charged: $______________

EXPRESS ENTRY if offered - Add $5.00 [___]

Men's [__] Singles Age Group: ______ or NTRP Level [___]

Women's [__] Singles Age Group: ______ or NTRP Level [___]

Doubles Age Group: _____ . . . Partner's name: _______________

Mixed Doubles Age Group: _____ . . . Partner's name: _______________

[__] Need Doubles' Partner . . . . . . [__] Need Mixed Doubles' Partner

Girls' [__] Boys' [__] 

Satellite [__]        Super Championships [__]        Championship [__] 
State Championship [__]         Jr. NTRP [__] 

Singles Age Group: ___________ . . . Doubles Age Group: ________

Partner's name: _______________ . . . Need Doubles' Partner [__]

Mixed Doubles Age Group: ________

Partner's name: _______________ . . . Need Mixed Doubles' Partner [__]

Medical Release: I hereby consent to emergency medical and/or hospital service that may be rendered by or at accredited hospitals, by appointed physicians, in the event such need arises in the opinion of a duly licensed physician.

Waiver and Indemnity Agreement: Acceptance of my entry in these events is without responsibility of any kind by the USTA, the STA, District Association, the host clubs, committees, or the management of any event in which I may be entered or may participate. In consideration of the acceptance of my entry, I do hereby for and on behalf of myself and my heirs and legal representatives release and forever discharge the USTA, the STA, District Association, and the host clubs, their officers, committees, and representatives and their successors and assigns, of and from any and all claims, demands, and injuries, however arising, whether caused by the negligent or intentional acts of the USTA/STA and its representatives, representatives of other sponsoring entities, or by third parties, which injuries may be in any way related to my activities during the tournament and any period traveling to or from the events described, and all such claims are hereby waived and released, and I covenant not to sue therefore. The parent or guardian, by signing below, does hereby agree to indemnify and hold harmless the USTA/STA and its representatives and the sponsoring entity from any liability which they may incur to the entrant, howsoever arising and whether caused by the negligent or intentional acts of the USTA/STA, its representatives, or the sponsoring body. I understand that this tournament will be governed by applicable USTA rules and regulations, the rules and regulations of this tournament, the rules and procedures governing discipline of players in USTA Southern Section and District sanctioned tournaments, the USTA Southern Section and district code of ethics, tournament policy, and ranking regulations and agree to conduct myself accordingly. I have read and understand the foregoing medical release, waiver and indemnity agreement.

Signature of player (or parent if under 18):

 
_________________________________Date: ____________