USTA Benefactor Foundation Club Membership
Donor Name/Group Name
First Name
Last Name
Shirt Size
Please Select
YM
YL
YXL
AS
AM
AL
AXL
AXXL
Donor to be listed as
If applicable
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
My Products
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$100 Donation (Medalist Club)
$
103.00
$150 Donation (Medalist Club)
$
154.50
$200 Donation (Medalist Club)
$
206.00
$250 Donation (Bronze Club)
$
257.50
$300 Donation (Bronze Club)
$
309.00
$350 Donation (Bronze Club)
$
360.50
$400 Donation (Bronze Club)
$
412.00
$450 Donation (Bronze Club)
$
463.50
$500 Donation (Silver Club)
$
515.00
$550 Donation (Silver Club)
$
566.50
$600 Donation (Silver Club)
$
618.00
$650 Donation (Silver Club)
$
669.50
$700 Donation (Silver Club)
$
721.00
$750 Donation (Silver Club)
$
772.50
$800 Donation (Silver Club)
$
824.00
$850 Donation (Silver Club)
$
875.50
$900 Donation (Silver Club)
$
927.00
$950 Donation (Silver Club)
$
978.50
$1,000 Donation (Gold Club)
$
1,030.00
Credit Card
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