Diana Tulman
  28 Canterbury Lane
  New Milford, NJ 07646





2014 Dr David Ostfeld Memorial ICA - FALL Championships
Sunday, September 21st, 2014 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