Please fill this out individually for each person participating (including payment). This info gets downloaded and used in the Vega chess software for the night.

Player First Name *

Player Last Name *

Date of Birth (DD/MM/YYYY Format) *

Male or Female *

male

female

Current Club Member *

Yes

No

Unsure

Current CAQ Member *

Yes

No

Unsure

First Time At Club *

Yes

No

Parent First Name

Parent Last Name

Phone *

Email *

Attendance - Choose $5 for adult or $3 for concession or skip if its your first night at the club.

AU$ 3

AU$ 5