CUSAT RATING OPEN CHESS TOURNAMENT

(Registration Form)

1) Name (in block letters)

 

2) Address

 

 

 

 

 

3) Date of Birth

 

4) Age as on 01-01-08

 

5) Please specify Category

(strike which not applicable)

General / Veteran / Senior Citizen / Local / U-8 / U-12 / U-14 / U-16 / U-18

6) Achievements

 

7) Titles

 

8) AICF Reg No:

 

9)FIDE Rating  (latest)

 

10)Whether contests in Chess Quiz

 

11) Signature of the Player

 

12) Mode of Remittance

      (If DD Specify DD No)

Cash / DD

13) Phone/ Mobile No:  
14) email-  

15)Type of Accomodation Needed

Dormitory / Furnished Accommodation

Mode of Remittance - Either in cash or DD drawn in favour of Secretary,CUSAT Chess Club payable at State Bank of Travancore, CUSAT Campus Branch, Cochin-22

Place:

Date :

(For Office use)

Regn fee :

Accom fee:

AICF Regn fee:

 

Total :