Course Registration Form

Registration Form

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

First NameMiddle NameLast Name
Child's Birth Date

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

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

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

Area CodePhone Number
Additional Comments
Choose a Subscription Plan
prevnext( X )
Annual Plan
£1,486.00 for each year



Quarterly Plan
£394.00 for each three months



Monthly Plan
£159.00 for each month
Special thanks to Jemis Mali for the icon graphics
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