Date:___________________________

Name:____________________________

Address:_________________________

___________________________

Birthdate:_______________________

School Name:_____________________

Coach:______________Grade:________

Phone no:_______________________

E-mail address:__________________________

USCF ID:__________Exp:____Rtg:_____

Monies collected:

EF Open ($20) _____

Sch. Open ($10)* _____

Sch. U800 ($5)* _____

Non-rated ($5)* _____

*ASAP schools $5 less

Section: Non-rated, level 1 __

(Beginners < grade 6)

Non-rated, level 2 __

(Non-beginners or grades 7+)

Memberships:

Adult USCF ($49) _____

Young Adult ($25) _____

(Ages 16-24)

Youth ($19) _____

(Ages 13-15)

Scholastic ($17) _____

(Ages <12)

PSCF ($5) _____

ages at end of membership