CAMP REGISTRATION FORM
Print - Fill Out - and Mail to the
Anatoly Karpov Chess School, 106 S. Main, Lindsborg, KS 67456
Last Name __________________ First Name ____________________
Address ___________________ City _________________ Zip ______
Home Phone _________________ Parent Cell # ___________________
Date of Birth ______ Age ___ Sex __ Grade ___ School ____________
USCF Member ID _____________ Rating _____ T-Shirt Size __________
Please indicate session 1 (July 10-15) _____ or session 2 (July 17-22) _____
Have You Attended Karpov Chess Camp in 2010? __________
Name of Parent or Guardian Submitting Payment __________________
Parent or Guardian's E-Mail ___________________________________
How many parents and/or siblings will attend the awards ceremony? ( )
Please List Those Items You Wish to Purchase
Basic Tuition Fee: $399.00 ___________________
Lodging at Bethany College Dorm: $129.00 _____________________
Refundable Key Deposit: $25.00 ____________
Linen and Towel Service at Bethany Dorm: $25.00 _________________
Meals: $109.00 ____________________
Minus any Applicable Discounts: ______________________________________
Total Fees: $ ______________________
I'm Paying by (Circle One) Check M.O. Credit Card (Online Only)
Today, I'm Paying (Circle One) $100 Deposit Only All Fees
Parent or Guardian's Signature _____________________ Date ______
Print Name of Parent or Guardian
Signing this Form ______________________________
Additional Information and forms will be sent to you prior to the start of camp. If you have any questions, please send e-mail to:
fisk@anatolykarpovchessschool.org
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