Blue Registration Card (Please Print Clearly) Blue Registration Card (Please Print Clearly)

Grade K - 4 Division Grade K - 4 Division

Full name (print clearly) ___________________________________________________ Full name (print clearly) ___________________________________________________

Street Address ___________________________________________________________ Street Address ___________________________________________________________

City ______________________ State ___________ Zip______________________ City ______________________ State ___________ Zip______________________

Area Code & Phone__________________________ Birthdate_____________________ Area Code & Phone__________________________ Birthdate_____________________

School Name ____________________________________________________________ School Name ____________________________________________________________

(For school name, do not use abbreviations or just list the school district) (For school name, do not use abbreviations or just list the school district)

Email Address ____________________________________________________________ Email Address ___________________________________________________________

If you have a chess rating, list your approximate rating here _______________________ If you have a chess rating, list your approximate rating here _______________________

I agree to abide by the rules and regulations of the Pittsburgh District Libraries/ I agree to abide by the rules and regulations of the Pittsburgh District Libraries/
Pittsburgh Chess Club Tournament and to participate in one library's tournament only. Pittsburgh Chess Club Tournament and to participate in one library's tournament only.

✎ Sign here _____________________________________________________________ ✎ Sign here ______________________________________________________________

Everyone should bring a chess set, board, and pencil. Everyone should bring a chess set, board, and pencil.
Please be at the playing site 15 minutes before the first round. Please be at the playing site 15 minutes before the first round.

Blue Registration Card (Please Print Clearly) Blue Registration Card (Please Print Clearly)
Grade K - 4 Division Grade K - 4 Division
Full name (print clearly) ___________________________________________________ Full name (print clearly) ___________________________________________________

Street Address ___________________________________________________________ Street Address ___________________________________________________________

City ______________________ State ___________ Zip______________________ City ______________________ State ___________ Zip______________________

Area Code & Phone__________________________ Birthdate_____________________ Area Code & Phone__________________________ Birthdate_____________________

School Name ____________________________________________________________ School Name ____________________________________________________________

(For school name, do not use abbreviations or just list the school district) (For school name, do not use abbreviations or just list the school district)

Email Address ____________________________________________________________ Email Address ___________________________________________________________

If you have a chess rating, list your approximate rating here _______________________ If you have a chess rating, list your approximate rating here _______________________

I agree to abide by the rules and regulations of the Pittsburgh District Libraries/ I agree to abide by the rules and regulations of the Pittsburgh District Libraries/
Pittsburgh Chess Club Tournament and to participate in one library's tournament only. Pittsburgh Chess Club Tournament and to participate in one library's tournament only.

✎ Sign here _____________________________________________________________ ✎ Sign here ______________________________________________________________

Everyone should bring a chess set, board, and pencil. Everyone should bring a chess set, board, and pencil.
Please be at the playing site 15 minutes before the first round. Please be at the playing site 15 minutes before the first round.