Player Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Photographic Release *

The above named participant and his/her legal guardian grant full permission for MOVTA to use, duplicate, broadcast, and/or publish photographic images for the purpose of promoting the Power Point Tennis program. Furthermore, the above names participant and/or legal guardian or parent, by completing this form, therefore claim no other liability for the use of the above names photographic image/likeness.

I agree.