Name: _____________________________________________ ICU Code: ___________Rating:__________ FIDE Rating (if applicable)___________ Club ___________________ Section Entered:___________________ Contact Phone number: ___________________________ E-mail address: ______________________ DOB:_________________________ Entry fee Enclosed:_________________
Please forward your entry fee to:
Gerry Graham,
86, Caislean na hAbhainn,
Castletroy, Limerick V94KN6W