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ENTRY FORM 08 Vic
Championships
Name
.........................................................
Address
...........................................................
Post code .........................
Telephone [ah]
Telephone
[bh]....................................
E-mail
.........Mobile.......................................
Tick the applicable fee
Entry fee $72..................................Concession
fee $48.........................
Number in preferred order [1, 2,
3. ] the events you are willing to play in
Victorian Championship
Victorian Championship Reserves
Victorian Championship Qualifiers
Victorian women's Championship
Victorian Seniors Championship
I am a member of the ..............................
C V affiliated chess club
Signature of the entrant
.
Post with entry fee to
2008 Vic Championships
cheques payable to the Chess Victoria
c/o 23 Chester Street Surrey Hills 3127
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