USTA/MID-ATLANTIC SECTION

CODE OF CONDUCT REPORT

Player’s Name _________________________________________

Tournament & Age Group ________________________________

Tournament Location ____________________________________

Date of Infraction _______________________________________

Violation:

Point Game Default

Description of Violation

Referee’s Signature: _____________________________________

Date_______

Player’s Signature: ______________________________________

Date_______

Each violation incurs a penalty.

Complete and return within 10 days of completion of tournament to:

USTA/Mid-Atlantic Section

7926 Jones Branch Drive, Suite 120

McLean, VA. 22102-3367

08masconduct