Membership Type Select Annual MembershipJunior $15Single $55Family $70 Renewed Memberships Due January 1 Each Year Checks Payable To: LHTA Mail Check To Andrew Maurer 3871 Canyon Cove Drive Lake Havasu City, AZ 86404 Phone: 928-846-0348 Contact Information First Name Last Name Phone Email Local Address Street Address City State ZIP Secondary Address (if out-of-state) Street Address City State ZIP Second Email (For Family Members) Player Details Skill Level BeginnerIntermediateAdvancedNTRP Rated NTRP Rating (if applicable) Interests SinglesDoublesMixed DoublesClinicsTennis LadderTournamentsExchangesYouth ProgramsLessons Release Of Information Call Primary Phone YesNo Call Secondary Phone YesNo Email Primary Email YesNo Email Secondary Email YesNo Emergency Contacts First Name Last Name Phone Emergency Contacts Address Street Address City State ZIP Email I agree the electronic signature I provide, whether digital or encrypted, included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures. The term “electronic signature” means any electronic sound, symbol, or process attached to or logically associated with a record and executed and adopted by a party with the intent to sign such record, including facsimile or email electronic signatures. The original graphic and pictorial appearance of a document, has the same effect as delivery of an executed original of this Agreement.
