Course Registration Form

Registration Form

Fill out the form carefully for registration
Your Child's Name

First Name Middle Name Last Name
Child's Birth Date

Month Day Year
Child's Gender
Chess Experience Level (of Child)
Chess Rating (if Known)
Your Name (Parent/Guardian)

First Name Middle Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent's E-mail
example@example.com
Mobile Number

Area Code Phone Number
Additional Comments
Choose a Subscription Plan
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Annual Plan
£ 2,111.00 for each year

Quarterly Plan
£ 587.00 for each three months

Monthly Plan
£ 194.00 for each month
Special thanks to Jemis Mali for the icon graphics
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