Team Name___________________________________________ Average Rating_________

1. Name_______________________________ Rating ______ USCF ID ______________
   
2. Name_______________________________ Rating ______ USCF ID ______________
   
3. Name_______________________________ Rating ______ USCF ID ______________
   
4. Name_______________________________ Rating ______ USCF ID ______________
   

Alternate (optional) Name____________________ Rating ______ USCF ID ______________

Entry Fee $118 ____
Junior $86 ____
Hexes (specify player) $20 ____
USCF memberships enclosed (indicate players) $ ____

Total enclosed $ ___

Make checks payable to SCCF.

Please print this form and mail to:

SCCF, c/o John Hillery
835 N Wilton Place #1A
Los Angeles CA 90038