20U born 1993 - 1996 16U born 1997 - 1998 14U born 1999 - 2000

12U born 2001 - 2002 10U born 2003 - 2004 8U born 2005 up

BOYS GIRLS

FAMILY NAME

GIVEN NAME

MIDDLE NAME

BIRTH YEAR

HOME ADDRESS

E MAIL ADDRESS

TELEPHONE NO.

CELLPHONE NO.

SCHOOL CONTROL NO. __________ Amount Date _________________________ __________________________ SIGNATURE I hereby confirmed that all information given are true and correct to the best of my knowledge.

Received by __________________________

This is to certify that Member ___________________________ has paid P 200.00 Registration Fee for 2013 NATIONAL AGE GROUP CHESS CHAMPIONSHIP LUZON QUALIFYING LEG CONTROL NO. __________

(NCFP) AUTHORIZED SIGNATURE

BOYS GIRLS

SEX

are true and correct to the best of my knowledge.

NAL AGE GROUP CHESS CHAMPIONSHIP LUZON QUALIFYING LEG