2016 Fall North-West LA OPEN ENTRY FORM (DEADLINE: POSTMARKED BY Wednesday, Nov.9, 2016Name (Last, First): ___________________________________________________________ Phone: _________________

Address: _______________________________________________________________ City: ___________________ State/Zip:_______________

USATT Membership#: ___________ Expiration Date: ______________ Rating: _____________ (Before / on USATT web site Nov.12, 2016)

Date of Birth: ____________ Email Address: ________________________________________ Main CLUB at which you play: _______________

I will abide by all regulations of the USATT and the Sponsors. I have signed (or will sign at the tournament) the Release and Waiver of Liability exempting USATTand the Sponsors from any liability for injury to myself or to my property.

Signature: ________________________________________________ (Parent or Guardian must sign for Minor)

Event No Event Name Rating Fee Sub total from leftAdministration Fee $8USATT Membership (1YR$75,3YR$210) (JR.1YR$45,3YR$125)

Event Fee Sub Total Total

Send check payable to “Allen and Sons”, mail to Allen & Sons Table Tennis Club, 21911 Sherman Way, Canoga Park, CA 91303. Or pay on Omnipongbefore Saturday Nov.12, 2016; after this date, no entries will be accepted.For timely draw scheduling purposes, players must register with tournament officials no later then 30 minutesbefore their first match (phone call is acceptable), or make full payment . If not, the player’s name will not beentered in the draw. Confirm entry on: www.mypingpongclub.com.

PrizeNo Event Name Time Fee1st 2nd

1 U2450 RR 3:30 $25 $200+medal $100+medal2 U2050 RR 11:00 $20 $100+medal $50+medal3 U1850 RR 1:30 $20 $80+medal $40+medal4 U1600 RR 3:30 $20 $50+medal $25+medal5 U1400 RR 9:00 $20 Trophy Trophy6 U1200 RR 1:30 $20 Trophy Trophy7 U1000 RR 11:00 $20 Trophy Trophy8 U800 RR 9:00 $20 Trophy Trophy

Official Tournament Equipment: Butterfly blue Tables, nets, barriers. *** Nittaku white plastic ball . Red rubberized mat floor.Entry Deadline: Nov.12, 2016, Saturday (On line entry). Space is limited to first 16 players for each event.

Registration: For timely draw scheduling purposes, players must register with tournament officials no later then 30minutes before their first match (phone call is acceptable), or make full payment . If not, the player’s name will not beentered in the draw. Please be ready to play each match 10 minutes before the scheduled starting time.Withdrawal: Prior Nov.12, 2016. There will be no refunds after that date.Ratings: on the USATT web site before and on Nov.12, 2016 will be used. Unrated player cannot advance in rating event RR group.Racket Control: Only ITTF &USATT approved equipment should be used.Policies: Players may not enter two events with identical start times. Events with insufficient number of entries can be cancelled orcombined at the discretion of the tournament committee .No prizes will be awarded for splits, dumps, default losses or no show. Playwill be conducted under ITTF rules. USATT dress code will be enforced. All decisions of the referee are final.Rules: The Laws of table tennis as published by the ITTF and all regulations apply. All matches will be best of 5 sets.Dress code: ITTF regulation dress code will be enforced, light bottom tennis shoes required to all players.Parking: In the back and next door, Chase bank parking Sunday is free.Open event: advance 2 players in RR group, if it is possible.

Referee: Linda Hsing NR, IUDeputy Referee: Lee Kondo, CR, IUTournament staff: Dinh Nguyen, Allen VernyProof of membership:

All participants must be current member of USATTor ITTF recognized body .Non members or thosewhose membership have expired must enclosemembership fees with their entry forms.

Venue: Allen & Sons Table Tennis Club21915 Sherman Way, Canoga Park, CA 91303(818) 330-5756

Sunday, Nov. 13, 2016