EVANSVILLE SCHOLASTIC CHESS CLUB MEMBERSHIP APPLICATION

APPLICANT INFORMATION Name: Date of birth: Current address: City: Grade: State: School: EMERGENCY CONTACT Parent(s): Address: City: Cell Phone: Relationship: OTHER SIBLINGS Name Name Name Name SIGNATURE OF PARENT OR GUARDIAN Signature: Date: State: Additional Cell Phone: Email: ZIP Code: ZIP Code: Todays Date: Phone:

We primarily contact all members by email, please fill this out if available. Mission Statement February, 2005 The purpose of the Evansville Scholastic Chess Club is to promote Chess activities for the students of Evansville, Indiana, and the community at large. As such, the Evansville Scholastic Chess Club accepts as its mission the responsibilities of:

Securing adequate facilities and equipment conducive to the playing of Chess Providing organization in support of such an exercise, the dissemination of Chess-related information Offering educational and instructional activities and materials Joining in inter-scholastic Chess activities Providing support for related endeavors

It is the vision of the Evansville Scholastic Chess Club to see a permanent cordial, stimulating, and selfsufficient environment for the pursuit of the royal game of Chess. Check below as appropriate:

Membership Dues are only $5.00 per player per year. Please make your check payable to Evansville Scholastic Chess Association, Inc. Click this box if you would like to join the United States Chess Federation and return with the completed USCF New Member/Renewal form. You may combine the ESCA membership and USCF membership on one check made out to ESCA, Inc. You do not have to join the USCF to be an ESCA member, but participation in our tournaments will be limited if you do not join.