78th Virginia Closed
BLITZ Entry Form
(One form per player)

Print this form, fill it out, and put your forma and payment in the mail by Tuesday Aug 26th
Send to:  Mike Hoffpauir, ATTN: VA Closed, 405 Hounds Chase; Yorktown, VA 23693
Checks payable to "VCF"

Last Name: _____________________

First Name: ______________    MI: ______

BLITZ IS OPEN TO ANY PLAYER ... NOT JUST VIRGINIA RESIDENTS.

USCF Member:     YES         NO               If Yes, write USCF ID Here:  __________________

Join or renew your US Chess Federation membership online at www.uschess.org, it's easier than joining or renewing at the tournament

Street Address:  _________________________

                          _________________________

Email:  ____________________

Phone:  ____________________

City:  ____________________,

State:  ________

Zip: ______________

Blitz Section you are entering (circle one):       OPEN (FIDE-Rated)            AMATEUR (under 1800 rating, USCF-Rated)

Entry Fee $25 until Aug 28th

 $35 if you wait to enter On Site

Your Total Payment:  _______