2003 Regionals Registration Form

Fill out and mail to:

Sharon Pernes

3401 Cromart Ave

Fort Worth, TX  76133

 

Name

Address

City, State, Zip

School

Grade

Section:

p Primary (K-3)

p Elementary u800 (K-5/6) p Elementary Open (K-5/6)

p Middle School (6-8/9) p High School (9-12)

USCF ID Number

Expiration Date

Rating

(February Supplement)

Do you need a bye? What round?

Amount Enclosed: ________________________

Check #: _______________________________