The Charlotte Table Tennis Club, Inc 
                      Membership Application          

 
                                 Name (first, last)__________________________________

                                 Address_________________________________________

                                 (city, zip)________________________________________

                                 Home Phone_____________________________________

                                 Business/Cell Phone_______________________________

                                 Email___________________________________________

 
                                                        Membership type:

                                      ____  Single    $15/month (paid $45 per quarter)

                                      ____  Family    $20/month (paid $60 per quarter)

                                      ____  Student  $10/month (paid $30 per quarter)

                                                    Dues are paid per quarter:
                       Jan/Feb/March       Apr/May/June       July/Aug/Sept       Oct/Nov/Dec

                     Remit membership application & payment to Tom Miller or John Pahl

                  This membership entitles you to benefits & access as listed in club bylaws
                 and supports our efforts in providing quality table tennis activities in Charlotte.        
                                       Please return this form with your first payment. 
                               It is your responsibility to keep your membership current.
                                   Dues are for membership, regardless of attendance.
                         You may pay a partial quarter upon initial membership payment.
                     All members and guests enter and/or participate at their own risk  & release
                       The Charlotte Table Tennis Club Inc & sponsors from any liability or injury.
                                               No pay / no play policy will be enforced.     

                                                       charlottettc@carolina.rr.com