USTA Middle States League Refund Request

USTA Middle States League Refund Request
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
USTA Membership #*
TEAM INFORMATION
Please List the Name of the Team, Team Number, District, Age Division, and Level that you would like to be refunded for.

If you need a refund for more than one team, please complete another form.
Please List The Team Name(s), District, Age Division And Level That You Would Like To Be Refunded For. *
Team Name*
Team Number*
District*
Age Division*

Adult 18&OverAdult 40&OverAdult 55&OverAdult 65&OverMixed 18&OverAdult 70&OverMixed 40&OverMixed 55&OverMixed COMBOFlex League DOUBLESFlex League SINGLESTri-LevelMixed Tri-LevelMixed Section ChampionshipsAdult Section ChampionshipsTri Level Section Championships
Level*

2.53.03.54.04.55.05.5FLEX6.06.57.07.58.08.59.09.510.0
Reason For Refund Request*

InjurySchedule ConflictNTRP Rating ChangeLeague CancelledPersonal ChoiceTransferring registration from Delaware Summer League to another League ($16.00 refund)
REFUNDS ARE IN CHECK FORM AND ARE MAILED.

THEY DO NOT INCLUDE THE $3.15 TENNIS LINK FEE.
Should be Empty:

TEAM INFORMATION