Printable Registration Form
L. I. BUGHOUSE Tournament - Friday, APR. 16, 2010 (Date to be confirmed)
TO ENTER: Please
write ONE check, or use ONE credit card for each Team’s Entry Fee.
Please check Pre-registration Lists
upon arrival.
c
rec’d by March 28: $14.00 per
player ($28.00/Team)
c rec’d April 1 - April 15: $17.00
per player ($34.00/Team)
April 16: On-Site (cash only - accepted 5:30 - 6:00pm only) –
$20.00 per player ($40.00/Team)
«CHOOSE A TEAM NAME: ________________________________________________________
c
If this is a
Parent-Child Team, please check this box to qualify for the
Parent-Child Trophy.
Board 1:
Name___________________________________________
Phone
_____________________
Grade: ____
Rating (or “Unrated”): ______
Board 2:
Name___________________________________________
Phone
_____________________
Grade: ____
Rating (or “Unrated”): ______
Address (or “same”)
Make check payable to:
L. I. Chess Nuts
Mail to: L. I. Chess Nuts - Bughouse,
or fill in
Credit Card info (1 credit card per Team) - mail to the above address or
fax to (516) 739-0535:
c Mastercard
c
Visa
c
Discover
Print Name, as it
appears on Card, & sign below:
____________________________________________________________
Account #:
_____________________________________________
Expir. Date:
___________
Total Charged (same as above): $
________