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2011 KnightMare Summer Camps 		The Chess Learning Center Logo

On-line Registration Form .

Instructions for completing this Summer Chess Camp Registration Form:

  1. If you leave this form for any reason, use your Web browser BACK BUTTON to return to this form.

  2. Please complete ALL form fields to ensure correct processing of form data.

  3. To pay by credit card, complete the registration information below and submit form. After submitting form and verifying information submitted, you will be given an opportunity to select payment by credit card.

You may register, using the on-line form (below) or by:

 Off-line Registration Form
Telephone: 614-231-9591
e-mail: ChessMaster@ChessLearn.com

Chess Learn Student Profile:

1.1

Name:


First Name
Middle Name
Last Name
1.2

Date of Birth:


Month
Day

  Example: 1988
 Year .........................
1.3

Grade/Age/Gender:
1.4

School:


(Enter name of school here.)

Chess Learn 2011 Summer Chess Camp Registration:

2.1

Please register my student for the KnightMare Summer Camp I
 Monday, June13 - Friday, June 17, 2011, Columbus, OH

2.2

Please register my student for the KnightMare "All Star" Summer Camp
Monday, August 15 - Friday, August 19, 2011, Columbus, OH

Chess Learn Student's Contact Information:
3.1

Street Address (line 1):

(Residence Address)
3.2

Street Address (line 2):

3.3

City:    State:   Zip Code:


(Enter State name here, if it's not listed in the drop down menu, above.)
3.4

Home Telephone:

 Example: 123-456-7890
Chess Learn Parent or Guardian Contact Information:
4.1  
First Name
Middle Initial
Last Name
4.2

Day Telephone:

Example: 123-456-7890
4.3 Evening Telephone:

Example: 123-456-7890
4.4

e-mail Address:


Example:  Your_e-mail@hostname.com

United States Chess Federation (USCF) Information:

5.1

Is the student a USCF Member:

5.2

USCF ID#:

USCF Chess Rating:
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Comments/Questions?
6.1

7.1

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Seminars & Camps Registration Form
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The Chess Learning Center
 Post Office Box 09726
Columbus, Ohio 43209-0726
Telephone: 614-231-9591  *  Fax: 614.231.9592
e-mail: Info@ChessLearn.com
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