Chess WP Youth Membership Form
Banking details - Youth Players:
Bank: Standard Bank ● Account Name: Chess Western Province Youth ● Account Number: 070423849 ● Branch Code: 020009
Proof of payment: Please send to youthchesswp@gmail.com

For further information, please feel free to contact:
youthchesswp@gmail.com

Please complete the following form:
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Membership *
Youth Player *
Born 2000 or later
Chessa Id *
Registering As *
Please select one or more
Required
Title *
First Name *
Surname *
Initials *
Preferred Name
Date of Birth *
MM
/
DD
/
YYYY
Gender *
E-Mail Address *
Please enter your email address or email address of parent or guardian
Cell Phone Number *
Do not type hyphens or spaces.
Address
School or University
If still studying
Parent/Guardian Name and Surname *
Parent/Guardian Contact Number *
Parent/Guardian Email Address *
Payment Reference *
R100 per member, capped to R200 per family. Please send proof of payment if already paid. Please see top of form for bank detail.
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