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MASONIC POSTAL CHESS CLUB
Membership Application
(Please Print)
Full Name _____________________________________________________________________
Nickname, if any, for rating report (e.g. Bill for William) ________________________________
Street Address _________________________________________________________________
City,State/Country,Zip ___________________________________________________________
Masonic Lodge #, Name, and Jurisdiction ____________________________________________
(Or OES Chapter, etc.)
Other Masonic Affiliations ________________________________________________________
______________________________________________________________________________
Masonic Honors ________________________________________________________________
Alternate address dates for "snow birds" (can be approx.) _______________________________
Alternate address ___________________________________________________________
City,State/Country,Zip _______________________________________________________
Birth date _____________________ Home phone (optional) _________________________
E-mail address _________________________________________________________________
Chess Strength (USCF rating, if you have one) _______________________________________
If you do not have a rating, circle your chess skill: Beginner Intermediate Advanced
How did you learn about the MPCC? _______________________________________________
Have you ever played chess by mail before? (Circle one) Yes No
Your first year’s dues are payable in advance:
\$20.00 for Regular members (under age 65)
\$10.00 for Senior members (65 or over)
Please make your check payable to MPCC
Please send this form and your check to: Dennis Plymette
371 Holly Hock Circle
Mountville, PA 17554-1252