L. I. Chess Nuts’ Jericho Scholastic Tournament  #26:  Sat. MAY 8, 2010

  

Name ____________________________________  Phone # _________________ Grade _____ Date of Birth __________

 Address __________________________________________  Town ____________________  State ___ Zip ___________

 USCF ID # (if any) ________________ Exp. Date ____ Rating (if known) _____ Name of School or Club/location _________

 u REGULAR, NOVICE, & GIRLS’ SECTIONS:     o JHS/HS  (7-12 grade, Under 1000)                 o Elementary (K-6 grade, Under 1000)

    o Novice Elem.  (4-6 gr., Under 600/Unrated)        o Novice Primary (K-3 gr., Under 600/Unrated)       o Girls (Girls, K-8grade, Under 800/Unrated)          

ENTRY FEE: o $20 Early Bird: by Mar. 27   o $22 Adv: by Apr. 30   o $28 Late: by May 7 @2pm      $32 On-site (cash only)  EF: $ ____

 u All-Star (Open to all thru age 24, recommended if your rating is > 1000):

 ENTRY FEE: o $27 Early Bird: by Mar. 27   o $29 Adv: by Apr. 30   o $34 Late: by May 7 @2pm   $38 On-site (cash only)  EF: $ _____

 âu USCF DUES (Required for all):  You MUST also add USCF Dues if not a current Member: 

        Yes, I am a current member  - enter info above, or:

        No, my dues are included (valid for all tournaments for 1 year):  o Age 24 & under: $24 (or, $32 includes 12 issues of Chess Life)

        o Age 16 & under: $20 (or, $27 incls 6 issues/Chess Life)      o Age 12 & under: $16 (or, $23 incls 6 issues/Chess Life for Kids)   

                                                                                   Plus USCF Dues: $ ______

u Refunds will incur a $3.00 processing fee

u Will you need to miss a Round?  If yes, enter Rd # ________                                  Total Encl: $ _______

u Make check payable to:  Long Island Chess Nuts   

Mail to: L. I. Chess Nuts - Jericho Tourn.,  P. O. Box 1515,  Mineola, NY 11501

     or Indicate Credit Card info: mail to above address or fax to (516) 739-0535:  o Mastercard       o Visa      oDiscover

     Account #  ____________________________________________   Exp. Date __________   Total Charge (same as above) $ ________

     Date  _______   Print Name  ___________________________________  Signature  ________________________________________