Full Name :___________________________If new address or school, check here___
Street Address :_________________________________Phone :________________
City :______________State:______Zip:__________Check one: Boy___ Girl___
School :____________________________ Grade:______(09-10) Birthdate:__________
Email (please print clearly)_____________________________________________
Please check the appropriate line:
____Students age 12 or under. Entry + Scholastic USCF membership ($32 if postmarked by 5/28, $37 later)
____Students age 13 to 15. Entry + Youth USCF membership ($36 if postmarked by 5/28, $41 later)
____Students age 16 to 24. Entry + Young Adult USCF membership ($40 if postmarked by 5/28, $45 later)
____Students with current USCF memberships. ($16 if postmarked by 5/28, $21 later). My USCF ID# and
expiration date are __________________________ Lookup here: http://www.uschess.org/msa

NOTE: USCF membership is required to play in the tournament.
If your membership expires prior to 6/30/10, you need to renew.