Greater New York Scholastics FAX Entry Form

Greater New York Scholastics Entry Form (v1)
Saturday - Sunday, January 26 - 27, 2013

INSTRUCTIONS

If you are mailing this entry form, print out the form below, fill out all items, and enclose a check for payment of all entry fee(s) and any USCF membership dues (all players must be USCF members thru at least 1/31/13)
payable (one check for the total amount is best) to:

THE CHESS CENTER OF NEW YORK, P.O. Box 4615, New Windsor, NY 12553

If you prefer to mail your credit card information to use for payment, you can provide your credit card information below.

MAIL ENTRIES MUST BE POSTMARKED NO LATER THAN JANUARY 4, 2013!

IF YOU MUST CONFIRM RECEIPT OF YOUR MAIL ENTRY, ENCLOSE A SELF-ADDRESSED, STAMPED POSTCARD: MAIL ENTRIES ARE NOT CONFIRMED BY PHONE!

Print the form below on your printer, fill out all items, and FAX it to us at 845-562-0991, NO LATER THAN JANUARY 11th.

We do not confirm FAX, mail or email entries individually. However a list of entries received should be posted at this website by January 24th.

Circle the tournament(s) and section(s) below for which you are paying the entry fee:

Saturday January 26, 2013

Primary Varsity (K-3 open, age 9/below)
Primary Novice (K-3, Under 700 or Unrated, age 9/below)
Primary K-1 (1st grade and below)
Junior High Varsity (K-9 open, age 15/below)
Junior High Junior-Varsity (K-9, Under 1200 or Unrated, age 15/below)
Junior High Novice (K-9, Under 700 or Unrated, age 15/below)
Sunday January 27, 2013
Elementary Varsity (K-6 open, age 12/below)
Elementary Junior-Varsity (K-6, Under 1000 or Unrated, age 12/below)
Elementary Novice (K-6, Under 700 or Unrated, age 12/below)
High School Varsity (K-12 open, age 19/below)
High School Junior-Varsity (K-12, Under 1600 or Unrated, age 19/below)
High School Novice (K-12, Under 1000 or Unrated, age 19/below)

Name of Player (Last Name, First Name, Middle):

Player's Email Address:

Street Addess of Player:

City, State, Zip of Player:

Birthdate (mm/dd/yy):

Grade:

School:

Address (city, state) of School:

USCF Membership is required. Please provide USCF information below:

USCF Status: (Current Member, Joining now, or Renewing Now):

USCF ID#:

USCF Expiration (mm/yy):

January 2013 USCF Rating:

Those who are joining or renewing now, please indicate membership type:

Membership Types
Premium Young Adult membership, age 24/below, $33 extra per player for 12 issues of Chess Life magazine, or
Online Young Adult membership, age 24/below, $26 extra per player for access to Chess Life Online, or
Premium Youth membership, age 15/below, $28 extra per player for 6 issues of Chess Life magazine, or
Online Youth membership, age 15/below, $22 extra per player for access to Chess Life Online, or
Premium Scholastic membership, age 12/below, $24 extra per player for 6 issues of Chess Life For Kids magazine, or
Online Scholastic membership, age 12/below, $17 extra per player for access to Chess Life For Kids Online.
USCF 3-Month Memberships: $10 extra per player, age 24/below, includes 3 issues of Chess Life magazine,
or $8 extra per player age 12/below, includes 2 issues of Chess Life For Kids.

Credit Card Information:

Type of card:

Card Number:

Expiration Date (mm/dd/yy):

Card Verification Number (CVN), 3-digit number (4-digits for AMEX), usually printed immediately after the Card Number:

Name of Cardholder:

Mailing Address of Cardholder:

Daytime Phone:

Evening Phone:

Email Address:

___________________________________________________________________

Signature Date

Signature of above cardholder authorizing this credit card charge for payment of chess tournament registration(s) and any additional USCF Membership dues, as indicated

THANK YOU FOR ENTERING THE 47th ANNUAL GREATER NEW YORK SCHOLASTICS!