Membership Application
NAME______________________________________
ADDRESS___________________________________
ADDRESS___________________________________
City,
State, ZIP_______________________________
TELEPHONE__________________________________
E-Mail
Address________________________________
Do you want a copy of our
Chess Bulletin mailed to you?______
Can be
viewed online at website.
Annual dues Semi-annual dues
Starts Starts
July to December January to July
Adult membership
$7.00 $3.50
Scholastic membership
$5.00 $2.50
Family membership $10.00 $5.00
(More than one member)
Amount enclosed Today’s date
_________________ _____________
Comments_______________________________________________
________________________________________________________
Send form to: Laurence
Coker, KCA Treasurer,