HOUSTON CHESS CLUB MEMBERSHIP FORM

Check ONE: NEW or RENEWAL

Name: _______________________________________

Address: _______________________________________

City: _______________________________________

State: ________

Zip: __________

Phone: ________________________________

Cell: ________________________________

Email Address: _______________________________________

MEMBERSHIP LEVEL

	ADULT (1 YEAR): $165.00
	ADULT (6 MONTHS): $95.00
	ADULT (3 MONTHS): $60.00
	SENIOR (1 YEAR)): $120.00 AGE 60 OR OLDER
	SENIOR (6 MONTHS): $75.00 AGE 60 OR OLDER
	COLLEGE (1 YEAR): $120.00 WITH ID
	COLLEGE (6 MONTHS): $75.00 WITH ID
	JUNIOR (1 YEAR): $120.00 AGE 18 OR UNDER
	JUNIOR (6 MONTHS): $75.00 AGE 18 OR UNDER
	FAMILY SIBLINGS (1 YEAR): $200.00 IN SCHOOL, SAME HOUSEHOLD
	FAMILY SIBLINGS (6 MONTHS): $120.00 IN SCHOOL, SAME HOUSEHOLD
	FAMILY (1 YEAR): $260.00 PARENTS AND CHILDREN
	FAMILY (6 MONTHS): $150.00 PARENTS AND CHILDREN
	WED ONLY (6 MONTHS): $100.00 NOT APPLICABLE TO ANY OTHER THAN MONTHLY 4 ROUND TOURNAMENTS HELD ON WED
	WED ONLY (1 YEAR): $60.00 NOT APPLICABLE TO ANY OTHER THAN MONTHLY 4 ROUND TOURNAMENTS HELD ON WED

I AGREE TO ABIDE BY THE RULES AND POLICIES OF THE HOUSTON CHESS CLUB. I UNDERSTAND THAT MEMBERSHIP FEES ARE NON-REFUNDABLE.

SIGNATURE: ___________________________________________

DATE: ____________________

If applying for a Junior Membership, application must also be signed by a parent. Parent – you are responsible for the behavior of your child and understand that he or she must abide by the rules and policies of the Houston Chess Club.

SIGNATURE: ___________________________________________

DATE: ____________________