Diana Tulman
  28 Canterbury Lane
  New Milford, NJ 07646





2011 Summer Camp Full Day
6/277/1; 7/47/8; 7/117/15; 7/187/22; 7/257/29; 8/18/5; 8/8-8/12; 8/15-8/19; 8/22-8/26 We promise 5:1 student - teacher/instructor ratio, prizes and trophies for tournaments and competitions, camp T-shirts and FUN!

ENTRY FORM
First Name:  Last Name:  Date of Birth: 
Home address: 
City:  State:  ZIP: 
Mother's Name:  Phone #: 
Father's Name:  Phone #: 
Home phone #:  E-mail:  USCF rating: 
Emergency Contact: 
Weeks' numbers: 1  2  3  4   5   6   7   8   9  Please check the week(s) number(s)
TOTAL ENCLOSED $________


Check should be made out to International Chess Academy
Mail the registration form and check to
Diana Tulman, 28 Canterbury Lane, New Milford, NJ 07646