List Request Form

1. You must submit the list request at least six weeks ahead of when you need it.

2. You must fill in all fields.

3. This list is only for a single use, which must be approved by USTA SC.

4. A copy of your mailing must also be submitted to USTA SC for approval before the list will be released.

5. You must agree to and sign a Personal Information Transfer Agreement (PITA), which can be found here.

Name of Requestor *

Email Address of Requestor *

Name of Facility *

Please Answer the Following Questions

Name of Event *

Date of Event *

Date of Mailing *

What type of event is your request for? *

League Tournament Jr. Team Tennis Others (please describe below)

If you chose other, please describe your event here.

Please describe what type of member should receive your mailing. *

Individual Schools Club CTAs Parks and Rec. Schools and Orgs

What ages of members would you like to reach? *

All ages All Juniors (18 and under) All Adults (18 to 50) All Seniors (50 and older) A Specific range (please detail below) Not Applicable

If you have a specific age range, please detail it here.

Who are the recipients of your mailings? *

Active members Expired members

If expired, for how long?

Please describe what level of NTRP player you wish to reach *

All NTRP levels NTRP 2.5 NTRP 3.0 NTRP 3.5 NTRP 4.0 NTRP 4.5 NTRP 5.0 and higher Not Applicable

Please detail what ZIP code radius you would like to reach. (___ miles around ZIP ____)

Please let us know any specific details on how you would like the list separated.

PITA agreement to sign here

Do you agree to abide by all terms in the PITA as outlined above? *

YES NO