Name ____________________________________________________________

Address __________________________________________________________

City/State/Zip______________________________________________________

Phone ___________________________________

E-mail____________________________________

Tickets (maximum 4 free daily for members)

Number of Tickets Requested:

Day 1 ___ x $5 = $____

Day 2 ___ x $5 = $____

Day 3 ___ x $5 = $____

Sub Total $ ____

Less Member Discount 100%

TOTAL $____

Method of Payment:

□ Money Order □ Check □ Credit Card

Visa or MasterCard#________________________________

Expiration Date ____________________________________

Signature __________________________________________

Return form and payment to:
USA Table Tennis, One Olympic Plaza, Colorado Springs, CO, 80909

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