Player's
Last Name: _________________________ |
First Name: ______________
MI: ______ |
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Section you are entering (circle one): K12 Rated/Open K5 Rated/Open K12 Not-Rated K5 Not-Rated |
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If you are playing in the Open Section, provide your USCF ID Number
or write "New" __________
J |
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Street Address:
_________________________
_________________________ |
Email: ____________________
Phone: ____________________ |
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City: _______________________, |
State: ____ |
Zip: _________ |
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School Attending in 2013-14: ________________________________; County: _______________ Grade in 2013-14: ________ |
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Optional Bye Requests (choose your bye by circling no more than 1 round): Rd 1 Rd 2 Rd 3 Rd 4 Rd 5 |
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Early Entry Fee is $15; Pay $20 if you wait to enter at the Tournament. |
Your Total Payment: _______ |