Last Name: _____________________ |
First Name: ______________
MI: ______ |
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USCF Member:
YES
NO
If Yes, write
USCF ID Here: ____________
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Street Address:
_________________________
_________________________ |
Email: ____________________
Phone: ____________________ |
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City: ____________________, |
State: ________ |
Zip: _________ |
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Blitz
Section you are entering (circle one):
OPEN (FIDE-Rated)
AMATEUR (under 1800 rating, USCF-Rated) |
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Entry Fee $25 by Mail before Aug 29th $35 if you wait to enter On Site |
Your Total Payment: _______ |