Name: ____________________ Grade:_____ Age: _____

Home Phone:____________________ Birthdate:__________

Mailing Address:

________________________________________

________________________________________

E–Mail Address:____________________

Web Address:____________________

Have you ever been a member of a chess club before?:____________________

Are you a member of the USCF?:____________________

Do you have a National Chess Rating?:____________________

If you are not rated, please circle your estimate of your skill level:

Beginner

You do NOT know how to move the pieces yet.

Advanced Beginner

You do know how to move the pieces, capture an

opponent’s piece and have played a few games.

Intermediate

You’ve played more than just a few games and have

an understanding of the en passant and castling

moves.

Advanced

You’ve played regularly at a club or at several

tournaments.