North Carolina Scholastic Championship XXXIII

One Entry Per Participant

Name:

Address:

City:  State:  Zip:

Phone:    e-mail:

School:

Grade:    Date of Birth

Section:    USCF ID:

Byes: circle 1 2 3 4 5 6 (no last round bye)

Fees Enclosed

   Entry Fee

   USCF Fee if joining or renewing

   Total check no _______________

Chess Coach*
  *Please nominate for Coach Of The Year

Complete and mail this form with a check made out to CMSCA to:

PO Box 221882
Charlotte NC 28222