Professional Tennis Registry

International Application for Membership and Certification

Please Note: If your browser does not support this form,
please print and fax application to 843-686-2033.
(printable view)

Contact Information
Prefix
First Name
Middle Name/Initial
Last Name
Suffix
Preferred Name/Nickname
Mailing Address
Address Line 2
Address Line 3
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
Fax
Cellular/Mobile Phone
Please select the phone number that you would like to have listed in the Membership Directory:
Email
Website

Personal Information
Gender	Female Male
Date of Birth

Experience/Employment Information
Total Years of Teaching/Coaching Experience
	Part-Time (less than 20 hours per week)
	Full-Time (more than 20 hours per week)
Playing Experience	High School College
Employment Status
Facility where you teach/coach
Position/Title
Facility Address
Address Line 2
Address Line 3
City
State/Province
Zip/Postal Code
Country
Phone
Email
Website
Is there a pro shop on site? Yes No
Other Experience

Referral
If you were referred to PTR by one or more people, please list their name(s):

Why did you decide to join PTR?


Workshop Registration
To reserve a space in a PTR workshop, select a date and location from the workshop schedule and enter the information in the space provided below. You will need to add the workshop fee of $95 on the next page to ensure registration.
I will select a workshop date/location at a later time by contact PTR Headquarters or registering online.

Code of Ethics
By checking this box I acknowledge that I have reviewed the PTR Code of Ethics and agree to abide by the rules of conduct as set forth. Please accept my application.

Payment Method	I intend to pay online with credit card.
	I intend to pay by mail mail with check/money order.
	I intend to pay by phone with credit card.



Thank you for applying to become a new PTR member! Disclaimer: online registration is not valid until payment is received by PTR International Headquarters.