Penn Go Society

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2007 Philadelphia Fall Open Registration Form

Save $5.00 off the registration fee!
Register online by Thursday, September 20, or print out and snail mail our registration form by Saturday, September 15, 2007.

To submit your registration form (and, if you wish, payment) via regular mail, please click here (you do not need to fill out the form below).

Alternately, you can fill out the registration form below, and send in your payment separately (mailing address follows after the form).

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	-OR- Not a member

Address line 1
Address line 2	(Optional)
City
US State
Zip / Postal Code

Phone Number
E-Mail Address
Entry Rank	Kyu Dan (unless you choose to self-promote, your AGA rating as of Saturday, September 22, 2007 will be used to determine your initial seeding in the tournament)
Date of birth (mm / dd / yyyy)
Name of parent / guardian if under the age of 18
In which event will you be participating:	Open (non-handicap) Handicap



AGA members, please choose from one of the following categories:	Open Division, ($55.00) Open Division, Saturday ONLY ($35.00) Open Division, Sunday ONLY ($35.00) Handicap Division, ($35.00) Handicap Division, Saturday ONLY ($20.00) Handicap Division, Sunday ONLY ($20.00)


Non-AGA members, please choose from one of the following categories
Youth (22 years or younger by 9/22/07):	Open Division ($65.00) Open Division, Saturday ONLY ($45.00) Open Division, Saturday ONLY ($45.00) Handicap Division ($45.00) Handicap Division, Saturday ONLY ($30.00) Handicap Division, Sunday ONLY ($30.00)
Adult:	Open Division ($65.00) Open Division & 1-year AGA Full Membership ($85.00) Open Division, Saturday ONLY ($45.00) Open Division, Sunday ONLY ($45.00) Handicap Division ($45.00) Handicap Division & 1-year AGA Full Membership ($65.00) Handicap Division, Saturday ONLY ($30.00) Handicap Division, Sunday ONLY ($30.00)

To submit this form electronically, click on "Send Entry" below. Payment may be sent separately to the address below, or at the door. To print out a copy of the above form to mail with your registration fee, please click here. Payment may be made with either a check or money order made out to "Peter Nassar", postmarked no later than Saturday, September 15, 2007, to the following address: Peter Nassar 300 N. Essex Ave. 206 A Narberth, PA 19072 - 2146 If paying at the door, please click on "Submit Entry" below, and we will see you at the Tournament!