American Chess Events

	2005 Arizona State Scholastic Chess Championship ENTRY FORM (Fill in completely, 1 entry per form) Click Here to Download a Printable PDF of the Entry Form

Section (Circle 1): K-1 K-3 K-6 Junior High High School Name: _______________________________________ Grade: ____________________ USCF #: _____________________ Expiration date: _______ February ‘05 Rating _______ School Name (Be complete e.g., “Pueblo” is different from “Kyrene de Pueblo”): ____________________________________________________________________ Is it a K-5 or K-6 school? (Circle one, Leave blank if playing in section other than K-6): K-5 K-6 Circle round numbers where player is requesting a bye: None 1 2 3 4 5 6 7 8 Coach Name: _______________________________________________________________ Player mailing address: ________________________________________________________ Player phone number: _________________________________________________________ Player or parent email address: __________________________________________________ Are you playing in the Blitz tournament Friday evening? YES($10 EF) NO Entry Fee (Circle One): $20 (if received by April 16) $25 (if received by April 26) $30 (if received by April 30) USCF Membership Status (Circle One): Membership Current New Membership (Submit date of birth) Renewing Membership -$13 Scholastic Economy Member (under 15) - $19 Scholastic Member (under 15) -$25 Youth Member (under 20) Add totals for entry fee, blitz entry fee, and/or USCF membership and make check payable to American Chess Events and mail to: PO Box 1804, Payson, AZ 85547. No email entries will be accepted. You may email to inquiry receipt of entries at: amchessevents@aol.com. Phone queries to: Steven Kamp, organizer, call: 928-478-0046.