New York Junior Championship Fax or Mail Entry Form



June 26 - 27 or June 27, 2010

INSTRUCTIONS



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 THE CORRECT ENTRY FEE ($58 for the 2-Day Schedule or $57 for the 1-Day Schedule), payable to: "Chess Center of New York."
 

OR

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.

OR

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.

OR

Cut and paste it into your email, fill it out, and  email it  to us at chesscentr@aol.com,  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.

Indicate below the section and schedule you would like to enter:

1. Open Section - 2 Day Schedule
2. Open Section - 1 Day Schedule
3. Under 1600 Section - 2 Day Schedule
4. Under 1600 Section - 1 Day Schedule
5. Under 1200 Section - 2 Day Schedule
6. Under 1200 Section - 1 Day Schedule

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

Player's Email Address:

Street Address 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):

(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:

Membership types:

Premium Young Adult membership, age 24/below, $32 extra per player for 12 issues of Chess Life magazine, or
Online Young Adult membership, age 24/below, $24 extra per player for access to Chess Life Online, or
Premium Youth membership, age 15/below, $27 extra per player for 6 issues of Chess Life magazine, or
Online Youth membership, age 15/below, $20 extra per player for access to Chess Life Online, or
Premium Scholastic membership, age 12/below, $23 extra per player for 6 issues of Chess Life For Kids magazine, or
Online Scholastic membership, age 12/below, $16 extra per player for access to Chess Life For Kids Online.
 

Credit Card Information

Type of card (Visa, Mastercard, Discover, American Express):

Card Number:

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:

Daytime Phone:

Evening Phone:

Email Address:

THANK YOU FOR ENTERING THE NEW YORK JUNIOR CHAMPIONSHIP!

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