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PTR on Campus Application for Membership & Certification

PTR on Campus offers a special discounted membership and certification price
for full-time students ages 16-24 Verification of enrollment is necessary.

Please Note: If your browser does not support these forms,
please print (printable view) and fax application to 843-686-2033.
Contact Information  
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
Cellular/Mobile Phone
Please select the phone number that you would like to have listed in the Membership Directory:
Email
Alternate Email Address
Personal Information  
Gender Female Male
Race/Ethnicity (optional)
Date of Birth
NTRP Rating What is my NTRP rating?
What organizations do you belong to?
(Select all that apply)
ATA USPTA
ATP/WTA USRSA
ITA USTA
Student Information  
Current education level:
School Name
Expected Month/Year Graduation
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?
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.