CajunChess.com
[email protected]: (504) 208-9596
1. PRINT THIS FORM2. FILL OUT ALL THAT APPLIES3. FAX OR MAIL IT
TO CAJUN CHESS
Cajun Chess Tourn. Reg.Cajun Chess Tourn. Reg.(504) 208-9620
MAIL TO:FAX TO:
PRINTABLETOURNAMENT REGISTRATION FORM
CAJUN CHESS PRINTABLE TOURN. FORM - AS OFWeb & Graphic
Design: MarkWebbDesign.com
Tourn. sign-up/registration is subject to customer verification
and approval of corresponding order form.You will be contacted
promptly upon our receipt of your order form.
Tournament Name:
Your Name (Last, First, M.I.):
Address:
City: State:
Telephone:
USCF ID#:
Rating:
Adult Section:(Check One)
Open U2000 U1800 U1600/UNR. U1 00 U1300 U1 00
Schedule:(Check One)
Scholastic Section:(Check One)
K-12 K-8 K-6 K-3 K-
1 Day 2 Day 3 Day
USCF Membership: If you are not a USCF member and wish to
purchase membership,listed below are the various types of
memberships available...
Scholastic members only: Date of
Birth(required):__________________
Registration Fees - Entry fee for your section and USCF
membership fee (if applicable):
Check
Money Order
Visa
MasterCard
Discover
Am. Express
Credit Card Num.:
CardHolder Name(as appears on card):
Security Code (last 3 numbers on back of card):
X Signature:
Exp. Date: /
Adult: Scholastic: USCF Membership: TOTAL: $
School: Grade:
Exp. Date:
E-Mail:
Zip:
Date:
12405 Hillary Step Dr.Olive Branch, MS 38654
Email:
1 /2012
$46 Adult/regular (ages 25 & over) with monthly Chess Life
Magazine. $40 Adult/regular (ages 25 & over) with no magazine.
$40 Senior (ages 65 & over) with monthly Chess Live Magazine.
$33 Young Adult (ages 24 & under) with monthly Chess Life
Magazine. $26 Young Adult (ages 24 & under) with no magazine.
$28 Youth (ages 15 & under) with 6 issues of Chess Life
Magazine. $22 Youth (ages 15 & under) with no magazine. $24
Scholastic (ages 1 2 & under) with 6 issues of Chess Life for
Kids magazine. $17 Scholastic (ages 12 & under) with no
magazine.
USCF Membership Fees for One-Year
memberships:
If your Sectionis not listed:
If your Sectionis not listed:
24
2K-4
