Summer Clinic Registration 2017

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EVENT: Chess EVENT: Chess

DATE: May 8-12, 2017 DATE: May 8-12, 2017


CHOOSE YOUR CATEGORY: picture CHOOSE YOUR CATEGORY: picture
_________ Kiddies (Primary Education) _________ Kiddies (Primary Education)
_________ Juniors (Grade 7-10) _________ Juniors (Grade 7-10)
_________ Seniors (Grade 11-12) _________ Seniors (Grade 11-12)

Name: _____________________________________________________ Name: _____________________________________________________


First Name Middle Initial Last Name First Name Middle Initial Last Name
Address: Address:
___________________________________________________________ ___________________________________________________________
___________________________________________________________ ___________________________________________________________
Gender: ________ Age: _______ Date of Birth: __________________ Gender: ________ Age: _______ Date of Birth: __________________
Nationality: _________________ Home Number: _________________ Nationality: _________________ Home Number: _________________
Email Ad: __________________ Mobile No: _____________________ Email Ad: __________________ Mobile No: _____________________
Current School: _____________________________________________ Current School: _____________________________________________
National Rating: ____________________________________________ National Rating: ____________________________________________
Chess Tournament Experience (NCFP Sanctioned Tournament since 2014) Chess Tournament Experience (NCFP Sanctioned Tournament since 2014)
___________________________________________________________ ___________________________________________________________
___________________________________________________________ ___________________________________________________________
___________________________________________________________ ___________________________________________________________
___________________________________________________________ ___________________________________________________________
Received by:______________________________ Received by:______________________________
Signature Over Printed Name Signature Over Printed Name

***(This serves as your ticket for the May 22, 2017 Tournament) ***(This serves as your ticket for the May 22, 2017 Tournament)

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