Junior Team Tennis Player Profile - 2018-19 Desired Team*10 & Under Green12 & Under Green12 & Under Yellow14 & Under16 & Under18 & UnderPLAYER INFORMATIONAthlete Name* First Last Gender*Select OneMaleFemaleDate of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*USTA Number*Membership is available at USTA.com.Expiration Date (must be current thru 9/1/2019)* Date Format: MM slash DD slash YYYY Grade*Select Your Grade4th5th6th7th8th9th10th11th12thSchool*City*Played Junior Team Tennis before?*NoYes with BBMPTYes at another clubPARENT INFORMATIONParent/Guardian Name* First Last Parent Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Home PhoneAdditional Email (to receive team info) Interested in being a Parental Captain at away Matches?*YesNoNeed more informationCURRENT ABILITY LEVEL Tournament……………….. Plays in numerous USTA tournaments Advanced..………………….Tournament level player who only plays an occasional tournament or none at all Intermediate………………..Does not play in USTA tournaments and has limited competitive experience High School (JV)………....Plays on high school junior varsity High School (Varsity).…...Plays on high school varsity AbilityCheck all that apply: Tournament Advanced Intermediate High School (JV) High School (Varsity) Coaching Information (optional)Private Coach First Last Club/ProgramAre you currently taking BBMPT clinics or private lessons?Select OneYesNoProgram or Pro?Select OneProgramProAre you currently taking clinics or lessons ELSEWHERE?Select OneYesNoWhere?Permission/PaymentPermissionI give Bob Bynum's Match Point Tennis permission to use my child’s picture and/or likeness in promotional materials.Payment*- $560 – Early Bird Registration ONLINE before October 11 - $610 – Regular Registration - Team fee includes practices. All players pay the team fee and are encouraged to attend practice. - Players pay $35 for each individual match that they play. Players will PRE-PAY every four matches.Registration before Oct. 11Registration after Oct. 12Total $0.00 How would you like to pay?*OnlineIn personNot ApplicableMailing AddressPlease mail payments to: Bob Bynum Match Point Tennis 19 Watchung Ave. West Orange NJ 07052
