BURLINGAME CHESS CLUB ENTRY FORM-- Print for use

Adult BCC Membership: $45/yr

Junior (under 19 yrs of age) BBC Membership: $25/yr

U.S.Chess Federation Membership: $40/yr (adult)----- $30/yr (senior over 65) (includes Chess Life Magazine subscription)

Youth USCF Membership: $20/yr (includes Chess Life Magazine)-under 19 yrs

Scholastic USCF Mem:$13/yr (includes School Mates Chess Magazine)-under 14yrs

Regular Swiss Tournament Entry: $15 (adult), $10 (Jr) For Goodwin Open--Link Here

Regular G/30 Chess Quad Tournament, 3 Rds: $10/5jr members; $55/30jr non-mem.

Quick Chess G/15 Quad Tourney, 3 Rounds: $10/5jr members; $15 for non-members.

Scholastic/Youth Special Tournament-early start time-5-7p, K thru Grade 9, $7 entry--all players. BCC mem & USCF mem not required for this one night tournament.

GM Patrick Wolff Simultaneous Exhib, Thursday March 29, 7:30 pm--- $25--adults,  $15--youth, Postmark by 3/24!

Entry Form--Burlingame Chess Club

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Name_______________________________________USCF#___________Expdate_________ Address___________________________________________ RATING________ City____________________________________ZIP___________

Phone(_____)_______________ [home] (_____)_______________ [work]

Email Address: ________@________________________ BCC Expdate_____________

Birthdate (Required for Juniors)______---_______---_______ ( month---day---year ) School __________________ Grade_______

ENCLOSED: $_______ Adult Tournament entry, $_______ Junior Tournament entry

Name & Date of Tournament/Event_________________________________________________________

$____ Adult CLUB Dues/1yr, ----- $_____Junior CLUB Dues/1yr

$____ Adult USCF/1yr/includes CHESS LIFE mag, ----- $_____ Youth USCF/1yr/CHESS LIFE mag,

$____ Scholastic USCF/1yr/SCHOOL MATES mag.

TOTAL: $_________ (checks payable to Burlingame Chess Club) Today's DATE____________

ALL INFO PROVIDED STRICTLY CONFIDENTIAL, HELD PRIVATE, & USED ONLY BY BCC OR USCF.

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Mail to: Tom Dorsch, P. O. Box 7453, Menlo Park, CA 94026

Email: TomDorsch@aol.com

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