Adult Summer Application 2019 2019 DVTA Summer Adult Online Application Please complete this form to register for DVTA's Summer Adult Programs. This form is for Packages which allows for your customized schedule. Sign up on the DVTA app or email desk@dvta.com to sign up for daily programs with or without a package Primary Contact InformationAdult contact information and emergency contact informationName*FirstLastAddress*Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip CodeDOB* Cell Number*Home Number*Work NumberEmail*Enter EmailConfirm EmailEmergency Contact*Same as Primary Gardian Add someone else as emergency contact Emergency Contact Name*FirstLastRelationship*(please choose one)SpouseSon/DaughterClose RelativeFamily FriendOtherEmergency Contact- Cell NumberComments or QuestionsMembership InformationSave up to $100 on each 10-package with a DVTA membership. DVTA members receive discounted rates on all DVTA activities including junior clinics, private lessons, pro shop and court rentals. $125 single memberships and $200 family memberships are available for purchase during the checkout page of this formAre you a a DVTA Member?*YesNo(if you are planning on purchasing a DVTA membership during check out, please select "yes" here in order to receive member rates for camp)What type of Adult Package (3.0-3.5 Level) would you like10-Package 2-hr Clinic Member $60010-Package 2-hr Clinic Non-Member $700What type of Adult Development (2.0-2.5 Level) Package would you like10-Package 1-hr Clinic Member $25010-Package 1-hr Clinic Non-Member $300What type of Round Robin Package would you like10-Package 1.5 hr Round Robin Member $10010-Package 1.5 hr Round Robin Non-Member $150Once your registration has been finalized in the office, you can sign up for classes on the DVTA app or you can do it on your home laptop/Computer: (Copy this URL) https://dvta.clubautomation.com/calendar/classes?calendars=11&date=06/17/2019 . If your DVTA profile has not been activated, we can do it for you. Let us know.Suggested By/Friend of:Please type in the name of the friend who will be attending or the friend you are accompanying to campAdult Summer Check OutWould you like to add a DVTA single or family membership to your purchase?(please select one)yes pleaseno thankyouWhat type of Membership would you likeSingle Membership ($125)Family Membership ($200)Total$0.00Name on Credit Card*Credit Card Number (MasterCard, Visa, Discover)Credit Card Number (American Express))C V V Number*Expiration Date (MM/YY)*Billing Zip Code*
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