119 Tennis Assoc. Membership & Activity Form

To become a member, please fill in the information requested below.

(All fields are required unless marked otherwise.)

There is an error with the following required field(s):

Player Information

First Name Last Name Address City, State, Zip Phone (xxx-xxx-xxxx) Type

Email YES, I would like to receive correspondence via E-mail.

Player rating (if you have one)

119TA Membership Member Dues for 2021: $50.00 Additional Donations (Thank you!) If your company has a matching gift program, please don't forget to send us the form.

Total amount to be charged to your credit card: $50.00

I'd prefer to pay by check.

If you prefer to pay by check, print this form after filling out the above portion. Checks should be made payable to RPC/119TA and mailed to:
119th Street Tennis Association
c/o Riverside Park Conservancy
475 Riverside Drive
Suite 455
New York, NY 10115

Billing Information

We value your privacy and we will not sell, lend or exchange your name.

First Name Last Name Address City State Zip Code Phone (xxx-xxx-xxxx) Email Cardholder Name

Card Number

Card Expiration Date Month Year

Security Code

If your company has a matching gift program, please don't forget to send us the form.

Credit Card Processing