Player Name: ___________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________________
School: ______________________________________________ Grade: ___________
Phone: ______________________ Email: ____________________________________
USCF ID#: _________________________ Exp. __________
For USCF signups: Birth Date ________________ Gender: Male Female
Section (Check one):
| ______ High School Championship | ______ High School Reserve (U-800) |
| ______ Middle School Championship | ______ Middle School Reserve(U-600) |
| ______ Elementary Championship | ______ Elementary Reserve(U-400) |
| ______ Novice K-2 (unrated) |
Entry Fee (Circle One):
| Championship Tournament Entry (free if you paid your $20 CSCL entry fee) | $10 |
USCF Membership (Valid for one year; Circle One):
| Membership is current | $0 |
| Novice player; none required | $0 |
| Scholastic (Age 12 & under) | $17 |
| Youth (Age 15 & under) | $19 |
| Young Adult Membership (Age 16 and older) | $25 |
| Family I : Both Parents and all children under 25 in same house | $64 |
| Family II: All children under age 25 in same house | $35 |
For Family Memberships, include the
names, USCF ID's and birthdates of the
other family members.
Total Fees Enclosed ________
Make checks payable to CSCL. Send COMPLETED form and fees to:
CSCL
P.O. Box 2373
North Canton, OH 44720