Individual Registration Form

Date: _________________________

Time: Registration 8:30am-9:30am, Competition 10:00am-4:00pm

Section:   _______________________                         Rated: K-5

                                                                                  Rated: K-8

                                                                                  Rated: K-12U1000

                                                                                  Rated: K-12Open

                                                                                  Non-Rated: K-3

                                                                                  Non-Rated: K-5

                                                                                  Non-Rated: K-8

                                                                                  Non-Rated: K-12

Player’s Name:  ________________________________   

Player’s School or Club:   ________________________________    

Player’s Grade:    ________________________     

Player’s United States Chess Federation Information

Rated section participants only

ID #      _________________________     Player’s USCF Membership ID Number

Rating   _________________________     Player’s USCF Rating

Exp.      _________________________     Expiration of Player’s USCF Memb.

Player’s Personal Information

Address:       __________________________    

                    __________________________                   

Date of Birth: __________________________    

Phone or email: __________________________