Diana Tulman
  28 Canterbury Lane
  New Milford, NJ 07646





2015 Dr David Ostfeld Memorial ICA U1600 Championship
2015 Dr David Ostfeld Memorial ICA U1600 Championship Sunday, January 11th, 2015 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: 
Entry fee:
Regular quad: $25
Blitz: $15
Section:  USCF Dues: 
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