Chesskid Gold Membership

Player First Name

Player Last Name

applicable Pay Email

ChessKid Username, if applicable

If you do not already have a ChessKid account, we will create a login for you.

Grade

Please select the player's current grade level from the drop down menu.

Player's School

What school does the player attend?

School's City

Please enter the city of the address of the school.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email Address

Required for confirmation emails and related purposes

Discounted Chesskid GOLD Membership

Price: $20.00

Pay with Paypal or Credit Card

Card Number

Expiration Date

Security Code

Card Holder Name