Last Name: ______________________ First Name: ______________________
E-mail address: ___________________________________________________
Street Address: ___________________________________________________
City: _____________________ State: ___________ Zip code: _________
USCF ID: __________________ Cell phone contact: ____________________
Section (check one): Open _____ U2000 _____ U1700 _____ U1400 _____
Schedule (circle one): --- 2-Day --- 3-Day
½ point bye (circle one if desired): -- Round 1 -- Round 2 -- Round 3 -- Round 4
Blitz tournament on Monday (circle one): ---- YES ----- NO
Nights booked at Blake Hotel (circle one): --- 0 --- 1 --- 2 --- 3 --- 4
Amount
Entry at $59 (N.C. resident received by 8/15):
Entry at $64 (N.C. resident received 8/16 - 8/29):
Entry at $69 (NC. resident registered on site):
Entry at $69 (out-of-state received 8/15):
Entry at $74 (out-of-state received 8/16 - 8/29):
Entry at $79 (out-of-state registered on site):
FREE ENTRY (GM’s and IM’s only):
Blitz tournament entry at $20 (flat rate):
USCF membership dues (on site only):
NCCA membership dues ($5.00):
Total Paid:
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Paid (circle one): cash or check and Check no:_________
Send entry to: Walter High, NCCA entries, 105 N. Crabtree Knoll, Chapel Hill, NC 27514.
Make checks payable to the NCCA.