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Billanook Chess Classic 2014 Registration Form

Name of participant Address Contact Number Contact E-mail ____________________________________________________________________ ____________________________________________________________________ ________________________ Mobile ______________________________

____________________________________________________________________

Please tick tournament(s) to register in: (Register for one or more tournament). Sunday May 25th (11:00 am start) Sunday September 14th (11:00 am start) Sunday July 27th (11:00 am start) Sunday November 23rd (11:00am start)

Please complete this section if registration is for a junior division Parent's name ________________________ Mobile ________________________________ Junior player gender (please circle) Male / Female

Junior player age ______________ at 1st January 2014

If you are 60 years of age or over on January 1st 2014, you are eligible for the Senior/60+ age division Are you eligible for 60+ age division? Signature of participant __________________________________________

(or Parent/Guardian for junior participant)

By registering with this form you are agreeing to the terms and conditions below:
An adult supervisor (parent or guardian) is required to be present with junior competitors for the duration of the event. Northern Star Chess provide Staff to organise the competition but not for child supervision. Photographs may be taken at this event and published in the local or state media, Northern Star Chess and/or Billanook College website, newsletter, magazine, or used in future advertising materials. By entering this event you agree to these terms, understand and accept this. Should anyone not wish their pictures to be published Northern Star Chess must be notified in writing prior to the event.

Post to: Northern Star Chess 17 Hartley Rd Wonga Park, Vic 3115

or Scan and E-mail to: BCC@NorthernStarChess.com

Payment: Cost is $20.00 per tournament. See below for payment methods.
Payment Method Cash Bank Transfer Please specify participant name as reference Online Payment (credit card/PayPal) BSB: Name: Acc#: Instructions Please tick here to pay cash at tournament sign-in 033 044 Northern Star Chess 105796

This option is only available from the Northern Star Chess website:

http://www.NorthernStarChess.com/Billanook_payment.html
17 Hartley Rd., Wonga Park 3115 Enquiries: 0407 072250

Northern Star Chess

ABN: 11 007 060 504