SPICE Chess Summer Camp

First Name: ____________________________ Last Name____________________

Address: ___________________________________City/State:_______________

Zip: __________ School: _____________________DOB:______________ Grade___

Phone: ______________________Email:_________________________________

Chess rating (if any)________________Amount enclosed______________________

Credit Card#______________________________________ Exp. Date__________

Commuter Plan / Residential Plan

Please PRINT all information and make check / money order to Susan Polgar Foundation and send it to 6923 Indiana Avenue #154 Lubbock, TX 79413.

For any questions or further info call 806-742-7742 or email spice@ttu.edu