MEMBERSHIP INFORMATION – OMAHA TENNIS ASSOCIATION

Return this form and payment to:

Omaha Tennis Association
PO Box 8313
Omaha, NE  68108-0313  

Or click here, to signup and pay online!

New member _______ Renewal ________ Today's date _____________
Last Name ___________________ First Name _________________ NTRP ____________________
e-mail  ______________________ Spouse____________________ NTRP ____________________
Address ____________________ City ________________________ State/Zip+4 ____________-________
Home Phone (       ) ____________ Work Phone (      ) _____ ____ __ Spouse's Work Phone (    _)___________
Children's names                                                                                                                                                                                                                       
Permission to print children's names in OTA Roster Book?     _____ Yes             _____ No

Terms of Membership (Check one)

TYPE (Select)

 ONE YEAR THREE YEARS FIVE YEARS

ENCLOSED
_____  Single Adult ___ $ 15 ___ $ 45 ___ $ 75  $ ________
_____  Junior (18 & Under) ___ $ 10 ___ $ 30 ___ $ 50  $ ________
_____  Senior (65 & Over) ___ $ 10 ___ $ 30 ___ $ 50  $ ________
_____  Family ___ $ 25 ___ $ 75 ___ $125  $ ________

OTA Development Fund Contribution: Tax Deductible.  Membership Included (No Charge)
_____  Club Contributor $35 - $84 (Single Adult, Junior, or Senior) $ ________
_____  Club Contributor $45 - $84 (Family) $ ________
_____  Champion Benefactor $85 - $164 $ ________
_____  Professional Patron $165 & Over $ ________

Checks payable to OTA &/or OTA Development Fund               Total Amount Enclosed  $ __________

Please use my Development Fund donation for: 
             Adopt-A-Schools Program                   Junior Scholarships                  Where the need is greatest