First Name(s)_____________________________ Surname _____________________________________

Address________________________________________________________________________________

Postcode______________________ Telephone Number _____________________________

Date of Birth___________________ School_______________________________________

Subscription Enclosed:

Full Year (£70 for 1st child, £65 for others)For established members

Autumn Term (£35 for 1st child, £30 for others) For new members who do not want to commit themselves to a full year

Associate Membership (£35 for 1st child, £30 for others) For those who wish to play for Richmond but don't come on Saturdays

Donation (Amount) _____

These figures include £5 parental membership per family, as required by the Charities Commission

TOTAL AMOUNT ENCLOSED ____________________

All subscriptions should be made by cheque or P.O. payable to RICHMOND JUNIOR CHESS CLUB.

Do you have a PC at home?
If so, does it have:
a CD-Rom?
Internet capability?
Do you have an e-mail address, either at home or at work? If so, what is it?

The above information will be stored in a computer database. Selected information may, if requested, be passed on to other chess organisers who are known to be trustworthy, for instance, Graders, Tournament Organisers, National Junior Squad Organisers, Captains/Managers of representative teams. If you do NOT want this information passed on please contact Richard James. If you receive telephone calls or other communications from Chess Organisers who are not known to you, and you would like their authenticity validated, again please contact Richard James.

Signed:___________________________ (Parent/Guardian)