Gujarat State Chess Association

(Affiliated to All India Chess Federation) (Reg. No.Guj.280/F-0363)

Rifle Club, Nr. Bhavan's College, Khanpur, Ahmedabad 380001
Phone : (079) 22113746 • E-mail : bhavesh.chess@gmail.com
Website : www.gsca.in

REGISTRATION FORM
(To be filled in Block Letters)
PHOTO
1) Name Mr./Ms. ______________________________
2) Date of Birth ______________________________
3) Father/Husband Name ______________________________
4) Address __________________________________________
__________________________________________
__________________________________________
5) Tel. with STD code __________________________________________
6) Mobile Number __________________________________________
7) E-mail ID __________________________________________
8) Languages Known __________________________________________
9) Name of the District __________________________________________
to which the
apprentice belongs
10) FIDE Rating _______________ FIDE ID: ___________________
11) Titles if any __________________________________________
12) I have enclosed my bio-data: Yes No
13) Was any disciplinary action taken against you? If yes, furnish details:
_____________________________________________________________
_____________________________________________________________

DECLARATION

1) I, _________________________________________age _______________
S/o / D/o _____________________________ declare that the particulars
given above are true to the best of my knowledge and belief.
2) I also declare that I shall abide by the rules and regulations and the latest
amendments and decisions of the District / State Association / Federation
as the case may be and cooperate with the officials in participating in State
and National Tournaments / Championships. I also declare that I will not
officiate in any un-authorized tournament / championship.

Place:
Date: Signature of Apprentice