Name__________________________________USCF ID_______________ Exp. Date______________
   (As shown on ID Card if USCF member)     ("NEW" if first time m'ship)

Address_________________________________________Section: Open, Reserve, Novice
                                                         (Circle one)    

City/State_____________________________________Zip__________

USCF Rating____________

BYE Request: I ______________________________ request a bye for round(s) 1  2  3  4.
              (Signature & Date)                                    [Circle Choices] 
                                                  No 5th round bye requests accepted 

Advanced Entry Fee @ $20 (On-site-$30)      $___________

USCF Membership: Type M'ship______________  $___________
Membership options and special website rates available via uschess.org (credit card 
payment available). Please bring printout verifying any on-line membership payments 
to registration check-in on October 10. No credit cards accepted for On-site 
entries.

Total Entry and Membership                  $___________

Single check payable to Huntsville Chess Club preferred. Indicate player name on 
check if different surname than check ID.