Corvallis Summer Open, August 20-21, 2005

Name:
Date of Birth (if submitting USCF membership dues):
Address:
City, State, Zip:
Phone:
E-mail:

USCF ID number:
USCF Expiration Date:
USCF Rating (August '05 Supplement):
Section: Open Reserve
Byes requested:

Credit Card #:
Expiration Date:

Entry Fee $: (Open: $49. $59 if received after 8/17. Reserve: $39. $49 if received after 8/17.)
USCF Dues $:
Total $: