* indicates required field
Adult 1 Name*
Adult 1 Email*
Adult 1 Cell Phone*
Adult 1 Date of Birth (be sure to scroll to your birth year, then select month and day)*
Adult 2 (if applicable)
Adult 2 Email
Adult 2 Cell Phone
Adult 2 Date of Birth (be sure to scroll to your birth year, then select month and day))*
Mailing Address:
Street*
City*
State*
Zip*
Additional Family Members (under age 25 living at home)
1 Name & Age
2 Name & Age
3 Name & Age
Sponsor
Name of EPTC member sponsoring your membership*:
Skill Level:
Will you be joining a League? Is so, which one(s):
Membership Process:
o Once your application is approved, you will be contacted by email. Payment is due within 30 days
o $590.00 Family Membership - includes all family members permanently residing at home; includes fee for balls for league play; includes APTA dues
o $295.00 Junior Membership - single person or partners, 35 and under as of October 1st; includes fee for balls for league play; includes APTA dues
Waiver of liability:
I/we hereby agree to release and hold harmless the Essex Paddle Tennis Club, its employees, Board of Directors, attorneys and successors, assignees and their respective representative from any and all claims arising out of my/our participation at Essex Platform Tennis Club. Further I/we release and discharge the club from any and all liability for any loss, or theft or damage to personal property. I/we acknowledge that I/we have carefully read this waiver and release and I/we fully understand that it is a waiver and release of liability and I/we assume any and all risk associated with my participation at the Essex Paddle Tennis Club. Furthermore I/we agree to the terms and conditions of the entry, registration, and membership forms.
Signature* (entering your name constitutes your legal signature):
Date*
