Grade Level Entry Form If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Information requested on this form is for the exclusive use of Cincinnati Scholastic Chess and, as applicable, the US Chess Federation for the sole purpose of enabling the entrant's participation in the 2019 Ohio Grade Level Championships chess tournament. Cincinnati Scholastic Chess will not give, sell, or make available this information to any other organization or individual except as required by law. CONTACT INFORMATION Having your contact information enables us to communicate with you if we have any questions about your entry and to notify you if there are any changes regarding the tournament. Parent/guardian name * Street address or PO box * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip code * Phone number with area code * If you have no phone, enter "000-000-0000". Email address * If you have no email, enter "none". PLAYER INFORMATION You may enter only one player on this form. If you have more than one player to enter, please complete and submit this form once for each player. Last name (and suffix if any) * First name * Middle name or initial Sex * FemaleMale Date of birth (m/d/y) * 2019-20 school grade * K123456789101112 School name * Enter the complete name of the player’s school or home schooling organization. School location (city) * Enter the name of the city where the player's school/home schooling organization is located. USCF membership status * Current active memberRenewing membershipPurchasing new membershipJunior Tournament Player All players in grades 4 through 12 must be current members of the US Chess Federation on the day of the tournament. USCF membership is optional for players in grades K, 1, 2 or 3; players in these grades choosing to play without a USCF membership must select the Junior Tournament Player option. Players can purchase a new membership or renew an expired membership by selecting a membership option below. USCF ID number * Players who have a current or expired USCF membership or who have played previously under the Junior Tournament Player Program are required to provide their eight-digit USCF ID number. This can be found on the player’s membership card or online at www.uschess.org/Ratings/Player-Rating Lookup by searching on the player’s name. If the player has no USCF ID number, enter “New”. Players can purchase a new membership or renew an expired membership by selecting a membership option below. USCF Membership Option Premium Young Adult - 1 year: $35 Premium Young Adult - 2 years: $65 Regular Young Adult - 1 year: $26 Regular Young Adult - 2 years: $48 Premium Youth - 1 year: $30 Premium Youth - 2 years: $55 Regular Youth - 1 year: $22 Regular Youth - 2 years: $40 Premium Scholastic - 1 year: $25 Premium Scholastic - 2 years: $45 Regular Scholastic - 1 year: $17 Regular Scholastic - 2 years: $30 If purchasing or renewing a USCF membership, select the desired membership option. Premium memberships include a subscription to Chess Life (12 issues/year for Young Adult and 6 issues/year for Youth) or Chess Life for Kids (6 issues/year for Scholastic). Regular memberships include only online access to magazine content. Whether paying for one year or two years, Young Adult members must be 24 years old or younger at membership expiration, Youth members must be 16 years old or younger at membership expiration, and Scholastic members must be 13 years old or younger at membership expiration. USCF memberships always expire on the last day of the month of purchase one or two years later. For example, a two-year membership purchased on June 1, 2019 will expire on June 30, 2021. Byes requested * Half-point byes are optional. Most players take no bye; however, players may take one half-point bye in rounds 1-4 if they wish. No half-point byes are permitted for round 5. No bye requestedBye for round 1Bye for round 2Bye for round 3Bye for round 4 CLOSING INFORMATION Total Payable Please note that this charge will show up on your statement as “PayPal Chess Fee” or “PayPal Chess Fee CSC”. Additional Information Use this text box to provide any other information you want us to know relating to your entry. I (Parent/Guardian) understand the organizers of this tournament will take all reasonable precautions customary and usual to conducting such tournaments, and beyond this I assume any risk associated with my child’s participation in it. I understand that the tournament directors, tournament organizers, the host venues and their employees are not to be held responsible in case of accident, and I agree to hold same harmless in the event of accident. In the event of a medical emergency, I hereby authorize emergency medical treatment for my child (if deemed necessary by a physician) if I am not at the tournament site and cannot be reached at the telephone number(s) listed below. Primary emergency contact * Enter a phone number for the primary emergency contact. Secondary emergency contact Optional: Enter a phone number for an alternative emergency contact. Signature * Entering the name of a parent or guardian here indicates acceptance of waiver and authorizes submission of this entry form. Click on the button below to submit your tournament entry and proceed to the payment page.