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 Karpov Chess Camp in 2011? __________
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
Grandmaster Camp (July 7-12, 2013) Basic Tuition Fee: $350.00
Lodging at Bethany College Dorm: $130.00 _____________________
Refundable Key Deposit: $25.00 ____________
Linen and Towels: Students bring their own.
Meals: $120.00 ____________________
Special Package $550 if by 4/30/13
Minus any Applicable Discounts: ______________________________________
Total Fees: $ ______________________
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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 ______________________________
Please print and return along with liabilty and medical forms
prior to the start of camp. These are available on the Chess Camps webpage.
If you have any questions, please send e-mail to:
fisk@anatolykarpovchessschool.org
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