Full Name:__________________________________________Circle: Boy or Girl
Mailing Address:_____________________________________________Phone:_____________________
School __________________________________Grade:________ Birthdate:______________
E-Mail Address:__________________________________________________________
USCF expiration date:__________(Membership must be valid through 6/30/08 or join/renew below)
Please enter me in: Adv Beginner ($40)_____ Intermediate ($40)_____ Advanced Class ($45)_____

Note: If the student or parent is a member of the Pittsburgh Chess Club or joins now, you are entitled to a $5 discount. Just reduce your check by $5. Your membership helps our club. We appreciate it!

Pittsburgh Chess Club annual membership for kids age 18 and under ($25)____ (optional)

US Chess Federation membership required for all students. To join or renew, check the appropriate box:
The USCF has eliminated the no magazine, economy ($13) membership. New membership options include:

Scholastic Membership (Age 12 & Under - includes 6 issues of Chess Life for kids) $17 _____
Youth Membership (Age 13 - 15 - includes 6 issues of Chess Life) $19 _____
Young Adult Membership (Age 16 - 24 - includes 12 issues of Chess Life) $25 _____
Family plan (gives membership to all kids under 24 in family;1 magazine per household) $35 _____
Adult Membership (Ages 25 & Up - includes 12 issues of Chess Life) $49 _____