WCCU CLUB REGISTRATION FORM

Chess Club Name
Club Email Address
Club Contact Person
Contact Telephone Number
Contact Cell Phone Number
Address 1
Postal Adress
Address 2
Town
Post Code
Province
CHESSA Registration
Club Chairman
Club Chairman's Telephone number
Club Treasurer
Club Treasurer's Telephone Number
Club Secretary
Club Secretary's Telephone Number
Club Secretary's Email Address
Club Captain Telephone Number
Club Captain Email Address
Method of Payment
Amount Paid
Other Information
Proof of Payment Upload
Todays Date