New Yorker June
Game/50 Open! Mail or FAX
Entry Form (v3)
Saturday, June 26, 2010
You can print the entry
form below on your printer, fill out all items, and
mail it NO LATER THAN JUNE 18th to us at:
Chess Center of New York
P.O. Box 4615, New Windsor, NY 12553.
BE SURE TO INCLUDE A CHECK OR MONEY ORDER FOR
$56, payable to
"Chess Center of New York."
If you want to use a FAX machine, print the form below on your printer, fill out all items, and FAX it to us at 845-562-0991, NO LATER THAN JUNE 22nd.
If you have a FAX modem, cut and paste it into your word processing program, fill out all items, and FAX it to us at 845-562-0991, NO LATER THAN JUNE 22nd.
Cut and paste it into your email, fill it out, and email it to us at firstname.lastname@example.org, NO LATER THAN JUNE 23rd.
REGISTRATION MUST INCLUDE FULL PAYMENT OF ALL ENTRY FEES AND USCF MEMBERSHIP DUES !!
We do not confirm FAX, mail or email entries individually. However, a list of entries received will be posted at our website by June 25th.
Circle the number of the section you would like to play in:
Half-point bye(s) may be requested in advance if unable to play which rounds (limit of two byes):
Last Name, First Name of Player:
Address of Player:
USCF Membership is required. Please provide USCF information below:
USCF Status: (Current Member, Joining now, or Renewing Now):
(8-digit) USCF ID#:
USCF Expiration (mm/yy):
June 2010 Official USCF Rating (or latest official, published rating):
Those who are joining or renewing USCF now, please indicate membership type:
Premium Adult Membership: $49/year (includes 12 monthly issues of Chess Life
Senior membership: age 65/above, $36/year (includes 12 monthly issues of Chess Life magazine), OR
Premium Young Adult membership: age 24/below, $32/year (includes 12 monthly issues of Chess Life magazine), OR
Premium Youth membership: age 15/below, $27/year (includes 6 bi-monthly issues of Chess Life magazine), OR
Premium Scholastic membership: age 12/below, $23/year (for 6 bimonthly issues of Chess Life For Kids)
Credit Card Information
Type of card (Visa, Mastercard, Discover, American Express):
Expiration Date (mm/dd/yy):
Card Verification Number (The
3-digit "CVN" is usually on the back, following the
main card number;
(except the American Express CVN is usually 4 digits, and is usually on the front of the card):
Name of Cardholder:
Billing Address of Cardholder:
THANK YOU FOR ENTERING THE NEW YORKER JUNE GAME/50 OPEN!