Full Name :___________________________If new address or school, check here___
Street Address :_________________________________Phone :________________
City :______________State:______Zip:__________Check one: Boy___ Girl___
School :____________________________ Grade:______ Birthdate:__________
Email (please print clearly)_____________________________________________
Please check the appropriate line:
____Pittsburgh Public School (PPS) students. Entry & USCF ($16 if postmarked by 5/31, $21 later)
____Non-PPS students, age 12 or under. Entry & USCF membership($33 mailed by 5/31, $38 later)
____Non-PPS students, age 13 to 15. Entry & USCF membership($35 mailed by 5/31, $40 later)
____Non-PPS students, age 16 to 24 Entry & USCF membership ($41 mailed by 5/31, $46 later)
____Non-PPS students with current USCF memberships. ($16 if postmarked by 5/31, $21 later). My USCF ID# and expiration date are____________________________(Check website for: Membership Info).

NOTE: USCF membership is required to play in the tournament. If your membership
expires prior to 6/30/08, you need to renew.