Full Name:__________________________________________Circle: Boy or Girl
Mailing Address:_____________________________________________Phone:_____________________
School __________________________________Grade:________ Birthdate:______________
E-Mail Address:__________________________________________________________
USCF expiration date:__________(Membership must be valid through 8/31/10 or join/renew below)
Please enter in: Beginner ($40) ____ Adv Beginner ($40)____ Intermediate ($40)____

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:

Scholastic Membership (Age 12 & Under - includes online access to Chess Life for kids) $16 _____
Youth Membership (Age 13 - 15 - includes online access to Chess Life) $20 _____
Young Adult Membership (Age 16 - 24 - includes online access to Chess Life) $24 _____
Family plan (gives membership to all kids under 24 in family and online magazine access) $35 _____
Adult Membership (Ages 25 & Up - includes online access to Chess Life) $29 _____