Membership

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NADI CHESS CLUB MEMBERSHIP FORM
Please complete this form and submit to the Secretary of the Nadi Chess Club together with the appropriate membership fees. Instructions Please complete the form in black or blue ink in BLOCK letters. Please place a tick in the appropriate box.

Personal Information First name Last name Date of birth (dd/mm/yyyy) Gender (Please tick only one box) Contact Details Telephone contact number Mobile telephone contact number E-mail address Postal address Emergency Contact Next of kin name Next of kin telephone contact number

Male:

Female:

Chess Experience How long have you been playing chess? What skill level do you estimate yourself at?
(Please tick only one box)

Beginner
(Understand how the pieces move)

Advanced Beginner
(Understand how the pieces move and capture)

Intermediate
(Understand the rules of chess)

Advanced
(Understand the rules of chess and participate in tournaments)

Have you been a member of any other chess clubs? Yes Do you have any current FIDE or Fiji Chess ratings? Yes

No No

Rating:

Conditions of Membership By signing below, I confirm that I understand and agree to the following; 1. Membership fees are non-refundable and that membership may be revoked at any time without prior notice, of any kind, via general club consensus. 2. Abide by the Code of Conduct of the club, which may change from time to time, by amendment to the clubs constitution. 3. To pay for all other charges for any goods and services charged as a result of direct and/or indirect damage caused by me and/or a guest of mine. 4. To wholly indemnify and hold harmless the club, its officers, agents and members from any and all claims of liability for injuries or illness sustained as a result, either directly or indirectly by me and/or a guest of mine Signature Date
Club Administration Use Only Membership fees paid on (dd/mm/yyyy) Receipt number Membership number

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