Forfeit Fine - Individual Registration

Player's Name (last, first) *

Purchaser's Name (Last, First) *

Purchaser's Email Address *

Player's First Name & Middle Name or Middle Initial *

Player's US Chess Membership ID # (Enter "none" ONLY if the player has never had a membership) *

Forfeit Fine *

$5: Scholastic Tournament: K-12. 1st Forfeited Round.

$20: Scholastic Tournament: K-12. 2nd Forfeited Round.

$50: Open Tournament: K-12 & adults. Any Forfeited Round.

Are you a K-12 MD resident rated 1400+ who wants to be invited to the annual Maryland Sweet 16 in March? See MDChess.com for more details. *

No

Yes

Coupon

Amount

$

Discount Amount

$

Gross amount

$

Payment Method

Paypal

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Individual Registration