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Non members add $40 (adults $60) for yearly membership ($80 for family membership).
Students Name: _____________________________ Grade: ______ DOB: ___________ Parents (Guardians) Name: _________________________________________________ Address: __________________________________________________________________
Street City State Zip
Home Phone: _________________________Work Phone: _________________________ Cell Phone 1: _________________________ Cell Phone 2: _________________________ E-mails: ___________________________________________________________________
Be aware that we use E-mail to distribute chess club information to all our members. A home or individual E-mail address is best as some company E-mail servers will block our mass E-mailings. We respect your privacy and do not share our E-mail list with anyone.