Player Name: ___________________________________________________________________________

Birth Date: ____________________________________

[  ] Male    [  ] Female

USCF Number (if you have one): ____________________________

Exp. Date: __________________

Check if you are   [  ] joining USCF      [  ] renewing USCF membership

Youth

$23

19 years and under - Receives 6 issues of Chess Life Magazine

Scholastic

$17

14 years and under  - Receives 5 issues of Chess Life Magazine and 1 Scholastic Yearbook magazine

Scholastic Economy

$12

14 years and under - Receives NO magazines.  ( If you can share in your household then this membership works well for siblings of those getting the magazines)

                USCF dues: $__________

Indicate the events you want to play in

[  ]

Tournament 1

June 17

June 24

July 1

[  ]

Tournament 2

July 8

July 15

July 22

[  ]

Tournament 3

July 29

Aug 5

Aug. 12

Enter the applicable entry fee:

$12 for one tournament

$20 for any two tournaments

$25 for all three

Entry Fee: $__________

Indicate which section you want to play in:

[  ] Open

[  ] Under 900

[  ] Under 500

Note: Sections may be revised depending on the total number of participants. Also, if you are entering more than one tournament, you may change sections after the first tournament.

Total dues and entry fees:

$___________

Parent/Adult Name(s):    ___________________________________________________________________

Address:_______________________________________________________________________________

Telephone (including area code): _________-_________-_____________

Email: ______________________________________________________________________

Write check for the total amount, payable to MetroWest Chess Club

Mail completed entry form and payment to:

Summer Program,   MetroWest Chess Club,   PO Box 1182,   Framingham,   MA   01701