PLAYER'S FULL FIRST & LAST NAME: PHONE:

ADDRESS: CITY: ZIP:

SCHOOL/CLUB: GRADE: DATE OF BIRTH:

E-MAIL: You will receive notification via e-mail of purchase for credit card entry

USCF RATING: USCF #:

IFTHE PLAYER IS NOT YET A MEMBER PLEASE JOIN BELOW

DEC 7= $45
JOIN OR RENEW USCF = $17 MUST BE A CURRENT MEMBER OF THE US CHESS FEDERATION OR YOU CANNOT PLAY

COUPON: Please indicate the kind.

TOTAL :


CREDIT CARD ENTRIES: VISA MASTERCARD AMERICAN EXPRESS

NAME ON CARD: CARD NUMBER:

DATE CARD EXPIRES: ELECTRONIC SIGNATURE:

  IMPORTANT: ALL PLAYERS MUST—MUST--CHECK IN BY 9:30 AM OR THEY LIKELY WILL NOT BE PAIRED AND THERE IS NO REFUND! ADVICE:  BE THERE BEFORE 9:30 AM TO BE SURE THAT YOU WILL GET TO PLAY.