First Name:

Last Name:

Address:

City, State, Zip:

Home Phone:

Email:

School:

Grade:

Section: Unrated Beginners Primary (K-3) Elementary (K-6) Middle School/High School (7 - 12)

If playing in the Primary, Elementary or MS/HS sections please answer the following (membership is required in these sections and available for purachase at the tournament):

Note - Check http://www.64.com/uscf/ratings/ for your rating and membership info.

Are you a USCF member? yes  no, I will purchase one at the tournament.

What is your membership number?

What is the expiration date?

What is your rating?

If you do not have a number yet and have purchased a membership recently, where did you purchase it?