Name of your Club :                                          

Name of Large City near your practice facilities: 

Club Website Address, if one:   eg www.clubname.com

Primary Director Information- all fields required

First Name:   Last Name:

Address:   City:  

Zip:

PHONE # to display on region website:  eg (803-555-1234)

Home Email:   ( Email to post on region website )

Work Email:

Secondary Director Information (if you have another director or someone who needs to be copied club information)

First Name:   Last Name:

Address:   City:  

Zip:

Home Phone:    eg (803-555-1234)

Work Phone:  eg (803-555-1234)

Cell:  eg (803-555-1234)

Home Email:  

Work Email:

Do you have interest in hosting a junior tournament ? Maybe Yes No

Do you have interest in hosting an adult tournament? Maybe Yes No