Membership and Entry Form

ENTRY FORM – School Holidays July 2009

Please print this form, complete it and post with your payment (cheque or money order).
(We regret that we do not have the facilities to accept membership applications or payments online.)

Send to NSW Junior Chess League, PO Box 262, Penshurst NSW 2222

Please make cheque or money order payable to NSW Junior Chess League and write player's name on reverse.
(No confirmation of entry is sent – please assume that your entry will reach us.)

Coaching Clinic: you must first book online (click HERE) or by phone (9412 4579) or email (eykoh@hotmail.com).
Tournaments: There is no need to book by phone or email unless your mail entry is likely to be late.

Family Name:		È Membership renewals are due in January each year
Family Name:		Membership (if due)	Coaching Clinic	Winter Tournaments		NSW Junior Championship		Late fee
Given Name	Date of Birth	Membership (if due)	Coaching Clinic	One-Day	Two-Day	Under 18	Under 12	Late fee




		Please fill in the $ amounts in the appropriate boxes.

We endeavour to keep our fees as low as possible. Your donation would be appreciated.
Total owing: $		Donation: $		Amount enclosed: $

Email address: ______________________________________________________________

2009 MEMBERSHIP APPLICATION/RENEWAL

Please complete if you are a new member or if details have changed – otherwise leave blank.

FAMILY NAME__________________________________ Home phone________________

Parent's contact phone during tournaments________________

GIVEN NAME_____________________________ Date of Birth________________

School________________________________________________________

Additional Family Members (brothers and sisters – for family membership):

GIVEN NAME_____________________________ Date of Birth________________

School________________________________________________________

GIVEN NAME_____________________________ Date of Birth________________

School________________________________________________________

ADDRESS_________________________________________________________________

_________________________________________ Postcode________________

EMAIL ___________________________________________________________________

The applicant(s) agree to be bound by the rules of the NSW Junior Chess League Incorporated for the time being in force.

SIGNED [by the applicant(s) or, if under 18 years of age, by his, her or their parent or guardian]

_____________________________________________________ Date________________