Ohio Scholastic Chess Association

Membership Application

(This is a shortened version of the application to appoint only one representative.  If you qualify

to appoint more and wish to do so, please use the full version available at www.chessohio.org)

Please complete all information and submit to OSCA Membership Secretary Grant Neilley via email grant@neilley.com, fax 614-448-9208, or mail Neilley & Co. CPAs, 2720 Airport Drive, Columbus OH  43219-2219.  Dues have been waived by the OSCA Board, no payment is required.

School Applying for Membership  (If applying as a home school, please also attach acknowledgement from your school district.)

School Name:

School Address:

City, State and Zip Code:

School Telephone:                                                                   School Email:

USCF Affiliate ID, if any:

Term applied for (two school years):  ______________________  thru _________________________

Appointed Representative  (Must have ready access to email) 

Representative Name

Address

City, State, Zip

Email (required)                                                                      Telephone

Principal’s Statement

I am the principal of the applying school and attest the information supplied is true and correct to the best of my knowledge and belief.  My school will make reasonable efforts to promote and facilitate the development of chess among our students and their participation in chess events outside our own school, and to maintain or establish a chess club.

______________________________________________________           

Printed Name

______________________________________________________            ________________________

Signature                                                                                                         Date

Rev 6-18-08