Tournament Date   Tournament Location

Tournament section (check "x" in one box): USCF rated      Unrated

Last Name          First Name

Date of Birth  E-mail address

Address         City   State       Zip Code

School   Grade

USCF Member ID  USCF/Local Rating (if applicable)   

I am not a USCF member and want to sign for membership

Tournament Entry Fee 

Membership (if applicable)

Total