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2007 U.S. Go Youth Championship Qualifier Pre-registration Form, due 11:00 p.m Thursday, April 12, 2007

All fields are required unless otherwise specified

Should you need to make changes after submitting the form, please email me (pnassar at vet dot upenn dot edu)

Once your form has been submitted, I will email you a confirmation within 24-48 hours. If you do not receive a confirmation within this time, please re-submit your registration data.

Family (Last) Name
Given (First) Name
Gender Male    Female
 
AGA ID   (AGA members who joined after January 22, 2007, or AGA members who do not meet the citizenship requirements for the USGYC tournament, will not be eligible to compete in this tournament)
 
Address line 1
Address line 2 (Optional)
City
US State
Zip / Postal Code
 
Phone Number
E-Mail Address
Entry Rank Kyu   Dan   (your AGA rating as of Friday, April 13, 2007 will be used to determine your initial seeding in the tournament)
Date of birth (mm / dd / yyyy)
Which event will you be participating Junior (12 or younger on August 6, 2007)
Senior (17 or younger on August 6, 2007)
Name of parent / guardian