Tournament Entry Form - The Mountain Lake Park Tennis Club

Western Maryland Tennis Championships
c/o Kathie Smith, P.O. Box 2157
Mountain Lake Park, MD 21550
August 2 - August 5, 2012
Entry Form

Name__________________
Birth Date_
Address         City____________
State_        Zip Code_
Home Phone #______
Cell Phone #
Arrival Date/Time
Email_

Where will you be staying during the Tournament?
Phone Number There:

INDEMNITY RELEASE: The above named entrant does hereby expressly and forever release and discharge the Mountain Lake Park Tennis Club, Inc., the tournament director and workers, and owners of any courts used in the tournament from any and all such claims, demands, injuries, damages, actions or causes of action as might be occasioned by his or her participation in the tournament or use of any courts.

By signing and submitting this entry, the players or parents/guardians whose signatures appear below agree to abide by the USTA Code of Conduct and consent to the discretionary right of the Tournament Director and the Director's Designees, including the Tournament Referee and Match Umpire, to impose sanctions on the players, including point and game penalties as well as immediate disqualification from any further play in the tournament based on tournament related conduct of the players and the players' immediate families and waive any right to institute any judicial action whatsoever against the Club or any person relating to the imposition of any such sanction.

Signature of Entrant or Parent/Guardian: _________

Date_ USTA Membership #     Exp. Date

Tournament Record or Ranking (if any):

_____________________________________

Categories of Play ENTER ONLY TWO EVENTS, PLEASE. The Tournament Committee reserves the right to cancel events where there are not eight (8) entries. ALL SINGLES PLAY WILL BEGIN ON THURSDAY, AUGUST 2, 2012 IN THE MORNING.

Please check the events you wish to participate in, total your charges at the bottom and enclose a check made to the order of The Mountain Lake Park Tennis Club. Mail your check to Kathie Smith, P.O. Box 2157, Mountain Lake Park, MD 21550. You may also enter though Tennis Link at www.usta.com. Sorry, no credit cards accepted when applying using the printable form..

_    Men's Open Singles - $30

_     Men's Singles(35) -  $30

_    Men's Singles(45)-    $30

_    Men's Singles(55)-    $30

_    Men's Singles(65)-    $30

_    Men's Singles(75)-    $30

_    Men's Singles(80)-    $30

_    Women's Open Singles-            $30

_    Men's Open Doubles Team-       $50
Partner Name:____________________________________

_    Men's Doubles(35) Team-           $50
Partner Name:____________________________________

_     Men's Doubles(45) Team-         $50
Partner Name:____________________________________

_    Men's Doubles(55) Team-           $50
Partner Name:____________________________________

_    Men's Doubles(65) Team-           $50
Partner Name:____________________________________

_    Men's Doubles(70) Team-           $50
Partner Name:____________________________________

_    Women's Doubles Team-             $50
Partner Name:____________________________________

_    Mixed Doubles Team-                 $50
Partner Name:____________________________________

_    Mixed 45 Doubles Team            $50
Partner Name________________

Total Amount enclosed for Entry Fees $.

Deadline for Entries - Wednesday, August 1, 2012

Thank you for your interest in our Tournament. We look forward to seeing you on the mountaintop!