STTC Membership Application

Select *
First Joined Date *For returning members (best guess)
First Name *
Last Name *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Email *
Phone *
Country of Origin
Additional Household Members
(Please list all members applying)
Annual Membership Dues
$48 Adults within 15 miles from club$36 Adults over 15 miles from club$24 Junior Only (17 and under)$24 each (Rochester site only)$6 each (additional household members)
Instructions All fees are half off for church members.
Fees are prorated for new members joining mid-year. (Our fiscal year begins November 1st)
Make checks payable to STTC.
Legal Waiver By completing and submitting this form, all named applicants hereby release any and all sponsors, Sangamon Table Tennis Club, Sangamon Table Tennis Club members, Douglass Avenue United Methodist Church, and Grace Bible Chapel from any and all claims, actions, or demands for any loss, damage, or injury sustained by any person or property. All named applicants assume all risk and responsibility for participation in any Sangamon Table Tennis Club function. A parent or legal guardian must be listed as an applicant on this form if applicant is a minor.