New Membership  [     ] Renewal  [     ]  Changes [     ] (Fill in new information only)

Name:  Last __________________________  MI  _____  First  __________________________
E-Mail Address:  _____________________________
Primary Mailing Address  ________________________________________________________
City/State/Zip  _________________________________________________________________
Home Phone:  _______________  Work Phone:  _______________  Cell Phone:  ___________
Secondary Address  _____________________________________________________________
City/State/Zip  _________________________________________________________________
Home Phone:  ____________________   USTA Number:  __________________    Year of Birth:  _______________________________
Life Membership    $400.00  $  _______________
Annual Dues for Year of __________  $  50.00  $  _______________
Joining after July 1    $  75.00  $  _______________
(New Member Only - Includes Following Year)
Membership Directory Binder   $    5.00  $  _______________
International Shipping:
Directory    $  15.00  $  _______________
Magazine    $15/Year  $  _______________
Total Amount Enclosed:  $  _______________ [     ]    Check              [     ]   Cash 
Date:  ________________________________
Make Checks Payable to NSWTA Mail to: NSWTA
    Post Office Box 7115
    West Palm Beach, FL 33405
    E-Mail:  NSWTA10@aol.com