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Name: Address: City: State: Zip: Phone (home): Phone (business): Email: USSRA/SCSRA #: Birthday (required for USSRA #): Division (choose one): 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 LAAC Membership #: Entry fee is $80. $15 refund for USSRA member upon presentation of a valid USSRA number at the tournament registration desk. Entry fee includes entry into one division, discounted parking, lunch Saturday and Sunday, Friday evening social in the Eight Floor Snack Bar Lounge, beer throughout the weekend, souvenir shirt, guaranteed seating for all men and women's professional matches, Saturday evening dinner and awards. Make checks payable to The LAAC Entries Close Friday, June 17, 2005

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