Given annually to a family who has exemplified the benefits of tennis and contributed to the community

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* 1. Nominated family and primary contact name:

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* 2. Nominee address:

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* 3. City:

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* 4. State:

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* 5. Zip:

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* 6. Phone:

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* 7. Email address:

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* 8. Family member (1) name, date of birth and USTA number:

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* 9. Family member (2) name, date of birth and USTA number:

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* 10. Family member (3) name, date of birth and USTA number:

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* 11. Family member (4) name, date of birth and USTA number:

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* 12. Family member (5) name, date of birth and USTA number:

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* 13. Nominator's name:

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* 14. Nominator's phone:

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* 15. Nominator's email address:

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* 16. Date submitted:

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* 17. Describe how this family has exemplified the benefits of tennis as a family recreational sport:

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* 18. Please describe how the family members give their time and efforts to improve tennis in their community by outlining their volunteer involvement. (Volunteer coaching, teaching, serving as team captains, running/assisting at events, etc.):

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* 19. Please share any additional significant information about this family in support of this nomination:

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