ClevelandChess - Entry Form

Cleveland Chess - Scholastic League

Application

Student Name__________________________________ Grade ____________

School _______________________________________________________

School Address ____________________________________________________

City ___________________________ State_________ Zip___________

School's Chess Club Sponsor ( parent or teacher) ________________________

Sponsor's Phone ______________________ - home

______________________ - cell

______________________ - other

Sponsor's Email ____________________________

Scholastic membership (Grades K - 8): $50 per team

Total amount enclosed: $____________

Mail completed entry forms and make checks payable to:

Daniel Patterson

c/o Cleveland Chess

11313 Lake Avenue

Cleveland, Ohio 44102

Phone: 216-281-1313

Email: Bsq451@sbcglobal.net