HEARTLAND SCHOLASTIC CHESS ASSOCIATION
MEMBERSHIP APPLICATION FORM

Print this membership application form, complete all required information, and mail it to: OJCA; 8309 NE 28; Spencer, OK 73084 with the appropriate fee to complete your membership.

** MEMBERSHIP APPLICANT'S INFORMATION **

Name: ____________________________________________________

Street/Box Address: _____________________________________________________

City/State/Zip: _____________________________________________________

Date of Birth:_____/_____/_____     School:_________________________________________

Telephone #: (______)______-________   Sex: Male or Female

USCF ID#: _______________________________ Expiration Date: ______________________


One-year Membership Fee (Circle):

Everyone:               $20 (gets OCF Bulletin four times a year and notices of upcoming tournaments)

Other items for sale:

$20 Chess Set (board and pieces) -- includes postage + handling fee

$60 Phileon Digital Chess clock -- includes postage + handling fee


USCF MEMBERSHIP APPLICATION
Name: ________________________________________________________________________________________

Street/Box Address: _____________________________________________________________________________

City/State/Zip: _________________________________________________________________________________

Date of Birth: _____/_____/_____       	Sex (circle):  Male or Female
Circle below the type of membership you choose:
  • Scholastic membership - $19 per year
    - includes Chess Life 5 times per year (for those 14 and under).
  • Youth membership - $25 per year
    - includes Chess Life monthly magazine (for teenagers 15-19).
      		• Circle below either new or renewal membership:
      • New membership
      • Renewal of current membership

      Go to | Heartland Scholastic Chess HOME PAGE |