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."
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.
Indicate below the section and schedule you would like to enter:
Name of Player (Last Name, First Name, Middle):
Player's Email Address:
Street Address of Player:
City, State, Zip of Player:
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:
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):
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 YORK JUNIOR CHAMPIONSHIP!