TO RECEIVE THE $5 PLAYER DISCOUNT YOU MUST HAVE SIX PLAYERS MINIMUM ON THIS FORM.  THEY CAN BE IN DIFFERENT DIVISIONS. TEAM ENTRIES MOST BE SUBMITTED ONLINE BY WEDNESDAY, FEBRUARY 4, 2015.

ACADEMIC SCHOOL TEAM NAME: 

ADVISOR/COACH'S NAME: 

COACH'S E-MAIL: 

COACH'S PHONE: 

TEAM MEMBERS:

In the box that follows please list team members names, USCF   ID # (a must to get discount), Expiration date, most current rating, DATE OF BIRTH, and the age group they are playing in.  PLEASE BE SURE TO PLACE THEIR ACADEMIC SCHOOL NEXT TO THEIR NAME IF THEY ALL DO NOT ATTEND THE SAME ACADEMIC SCHOOL.

Each player is $35.

TOTAL:

PLEASE INDICATE METHOD OF PAYMENT: Check Credit Card
If you are paying by credit card, please fill out the information below.  If you prefer you can pay through Paypal. Please contact CalNorthYouthChess@gmail.com for arrangement.

If paying by check, mail no later then Tuesday, February 3.  Please make the check out to SUCCESS CHESS SCHOOL and send it to me Carl Moy., at 833 Phoenix Ct, Fremont, CA 94539.

CREDIT CARD ENTRIES: Visa MasterCard American Express

NAME ON CARD:

CARD NUMBER: 

DATE CARD EXPIRES:

ELECTRONIC SIGNATURE: 

(LATE REG = at site if space is available before 9:30 AM.  Late entrants will not play the first round and will receive a zero point bye for that game.)

*No refunds after Saturday, January 31.  However, if Carl is notified before the tournament starts of an emergency where you cannot attend, an 80% credit of what you paid will be provided for a future Success Chess School/Weibel Chess tournament. Player substitutions can be made as long as they are done by Saturday, February 7 before noon.