MEMBERSHIP FORM Membership Number

APPLICANT/PLAYER DETAILS
Is this application being made for yourself or on behalf of a child (under 18)? Myself A child (minimum age is 6)
Applicant’s Name

Applicant’s Address PR Postal Code

Applicant’s Phone Number Applicant’s E-mail Address

Player’s Name (if different from applicant)

Player’s Address (if different from applicant) PR Postal Code

Player’s Phone Number (if different from applicant) Player’s E-mail Address (if different from applicant)

Please complete the following if the player is under 18

Emergency Contact Name Emergency Contact Phone Number Player’s Date of Birth

DD / MM /YYYY
Please note, children 10 and under must be accompanied by a parent or guardian during club.

PLAYER INFORMATION
What are your reasons for Blitz / Speed play Chess Club Events Social Setting
joining the Waterdown Chess Camps / Workshops Lectures Tournament Play
Club (check all that apply): Casual Play Lessons / Tips Other _________________________

What would you consider the players level of competetive chess play to be (circle one):

HAS NEVER HAS A BASIC THEIR MOM CAN PLAY BUT HAS HAS SOME HAS WON HAS PLAYED AT
PLAYED CHESS UNDERSTANDING THINKS THEY’RE NEVER PLAYED TOURNAMENT SOME LOCAL INTERNATIONAL
BEFORE OF THE GAME AWESOME COMPETETIVELY EXPERIENCE TOURNAMENTS TOURNAMENTS

How many years have CFC Current Current Current

you played chess? Member ID: CFC Rating: FIDE Rating: FIDE Title: MEMBERSHIP TYPE
Full Year (10 months) $150* PAID
Half Year (5 months) $80* PAID
TERMS AND CONDITIONS Walk-In (casual play) $5/game
All price levels include rating fee. Full and half year members aged 20 and over are
required to have a CFC membership.The Waterdown Chess Club reserves the right to use * Includes workbook for new club members
photos and names of our members for promotional purposes.The Waterdown Chess Club
reserves the right to revoke the membership of any player for reasons including but not Payment can be made in cash or by cheque.
limited to poor sportsmanship, cheating, or failure to provide membership payment. Space Make all cheques payable to Waterdown Chess Club.
in the club is limited. Please keep your membership dues current to avoid losing your spot.

Waterdown Chess Club

68 Cole Street, Waterdown
Meeting at St. James United Church
I have read and agree to the terms and conditions (signed & dated) 306 Parkside Dr, Waterdown