Entry form

  Diana Tulman
  28 Canterbury Lane
  New Milford, NJ 07646

2010 Chess Camp With GM Artur Jussupow & GM Alex Chernin & GM Alex Stripunsky
For the 11th consecutive Summer the International Chess Academy is offering the strongest chess players in the world the unique opportunity to study chess in the residential program with the best coaches in the world: GM Artur Jussupow!, GM Alexander Chernin! & GM Alexander Stripunsky

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 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