Diana Tulman
  28 Canterbury Lane
  New Milford, NJ 07646





Dr David Ostfeld Memorial ICA WINTER 2013 Scholastic Championships
Sunday, February 10, 2013 Bergen Academy 200 Hackensack Avenue Hackensack NJ

ENTRY FORM
First Name:  Last Name:  DOB: 
Home address: 
City:  State:  ZIP: 
School:  Grade: 
USCF #:  Exp. Date:  Rating: 
Phone #:  E-mail: 
Section: 
TOTAL ENCLOSED $________


Entry and membership checks should be made out to International Chess Academy
Mail entry to Diana Tulman, 28 Canterbury Lane, New Milford, NJ 07646
For more information call: (201) 287-0250 or (201) 833-1741