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 __________
Have You Attended Previous Karpov Chess Camps? ___ When? _____
Name of Parent or Guardian Submitting Payment __________________
Parent or Guardian's E-Mail ___________________________________
I Will Be a Resident Camper (Staying in the Dorms with Meals) Yes No
I Will be a Commuter Camper (No Lodging or Meals) Yes No
I Want the $25 Linen / Towel Service in my Dorm (Circle One) Yes No
I'm Paying by (Circle One) Check M.O. Credit Card (Online Only)
Today, I'm Paying (Circle One) $100 Deposit Only All Fees
Total Fees _____________________ (See Fee Schedule on Camp Page)
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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