2017 ITF Super Seniors Team Championship Application
October 8-13, 2017
Orlando, FL
Age Divisions: 65, 70, 75, 80, 85 (Men Only)

Team Application

By completing this application, you may be considered for the 2017 ITF Super Seniors cup team selection, provided you have otherwise met the team selection requirements. The team selection will be held June 1, 2017.

This application is due by April 15th, 2017.

If you have any questions about the application, please feel free to contact Rob Gorden at robert.gorden@usta.com.

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* 1. USTA Number
Please double check to make sure you have entered your correct number

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* 2. ITF IPIN Number (or enter "will apply" if you have not yet obtained one)

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* 3. Player Information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 4. On which teams are you interested in playing?

Men's 65

Men's 70

Men's 75

Men's 80

Men's 85
(Division will only be held if ITF gets enough teams)

Women's 65

Women's 70

Women's 75

Women's 80

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* 5. To be considered for the team selection, please certify each statement by checking each box:

I certify that I am interested in playing if selected.

I understand that I must meet the minimum tournament play requirements by the posting of the eligibility list on USTA.com.

I certify that I am a US citizen and have a valid US passport. If not, see the next question.

I certify that I am able to arrive at the venue by October 7th, 2017 and remain until October 14th, 2017.

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* 6. If you hold a passport from any other country or have started the process of becoming a US citizen, please specify which country and email a copy of that passport to robert.gorden@usta.com.

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* 7. I certify that I am in good health and am prepared to undertake the extensive travel and strenuous physical exertions that will be required of team players.

Yes

No (Please Explain)

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* 8. Are you willing to be the playing team captain if selected to the team?

Yes

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* 9. ITF Requirements:

I certify that I have lived in the United States of America for 24 consecutive months and I have not played on an international team for any other country in the past 36 months.

I certify that I am not eligible to play for any other country.

I have an ITF IPIN, or will obtain one before July 15, 2017.

Eligible Player List: The list of Eligible Players who will be considered for cup team selection will be posted on USTA.com by April 20, 2017. Eligible players who have applied for consideration have until April 25, 2017 to notify the USTA if their name has been omitted from that list.

Insurance: The USTA maintains a Travel Accident Insurance program, providing benefits for accidental death and dismemberment; as well as, a medical component. The coverage is extended to insure all USTA staff, teams, coaches, trainers, and USTA tournament officials when on official USTA business. While the USTA’s coverage is consistent with the ITF Regulations and requirements, the ITF, the title sponsor, the host association and the host venue cannot accept any liability for any participant or visitor in this respect. All team cup players and their guests should consider arranging separate coverage outside of the USTA policy that would be in line with your individual requirements.

Player Stipend: Players selected for a cup team will receive a stipend in the amount of $1,000 upon receipt of their completed player agreements.

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* 1. USTA NumberPlease double check to make sure you have entered your correct number

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* 2. ITF IPIN Number (or enter "will apply" if you have not yet obtained one)

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* 3. Player Information

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* 4. On which teams are you interested in playing?

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* 5. To be considered for the team selection, please certify each statement by checking each box:

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* 6. If you hold a passport from any other country or have started the process of becoming a US citizen, please specify which country and email a copy of that passport to robert.gorden@usta.com.

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* 7. I certify that I am in good health and am prepared to undertake the extensive travel and strenuous physical exertions that will be required of team players.

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* 8. Are you willing to be the playing team captain if selected to the team?

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* 9. ITF Requirements:

* 1. USTA Number
Please double check to make sure you have entered your correct number