L. I. Chess Nuts’ Jericho Scholastic Tournament  #31:  Sat. Nov 5, 2011

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 $22 Adv: by Oct. 29  

                           o $28 Late: by Nov. 4 at 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 $29 Adv: by Oct. 29

              o $34 Late: by Nov. 4 at 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)

                                                                           Plus USCF Dues: $ ______

u Refunds will incur a $4.00 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      oDisc

     Account #  ___________________________________________   Exp. Date _____   Total Charge (same as above) $ ________

     Date  _______   Print Name  ___________________________________  Signature  _____________________________________