Registration Form for Chess Tournament
Please select day and tournament you would like to register for. You may make multiple selections.
January 19, 2019
Quad - 9:30
Swiss 1:00
February 16, 2019
Quad - 9:30
Swiss 1:00
Your name:
Childs Name:
School:
March 16, 2019
Quad - 9:30
Swiss 1:00
April 27, 2019
Quad - 9:30
Swiss 1:00
Email:
Childs Grade:
Tournament:
 May 18, 2019
Quad - 9:30
Swiss 1:00
June 15, 2019
Quad - 9:30
Swiss 1:00
Credit Card #
Security Code:
Expiration Date:
Add on Items for sale
Small Chess Board = $10.00
Large Chess Board = $15.00
Chess Clock = $35.00
Billing Zip Code
Do your have a code?
Please use the form below to register your child for the chess tournament. Please include grade and school. You
may make a payment online with a credit card or through paypal. You may also register on-site with check or
cash. Please bring a lunch or snack for your child as the tournament will last about 5 hours.

2 - FREE RAFFLE TICKETS PER ENTRY

Raffle prizes include: private lessons, clocks, chess boards, tournament entries, chess books signed by Susan
Polgar, Instructional chess Dvd's, Discounted chess class and more!
Tournament will be held at:

Oak Avenue Church
8790 Oak Ave, Orangevale, CA 95662

Time: USCF Rated Quads 9:30 - 12:30
Unrated Swiss 1:00pm - 5:00pm
U.S. Chess Mates