22^nd North American Championship June 24^th to 28^th 2011 , Walpole, MA, USA

                                                   REGISTRATION FORM

Last Name:	First name:
ISPA Membership Number:	Birthdate
Address:	Postal Code/Zip Code:
Telephone:	City:
Email:	Country: Select One Canada USA Argentina Australia Austria Bahamas Belgium Bermuda Brazil Chile Denmark France Germany Netherlands Paraguay Poland Repablic South Africa Spain Switzerland Thailand
Province or State: Select One Other Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming	Club :

  I LIKE TO REGISTER FOR THE FOLLOWING (Please click on the circles to indicate Yes or No)

Yes (or) No

	Organizing fee (must be paid)	US$ 65.00
June 23^rd	Pre-Tournament	2 Rounds US$ 20.00
June 24^th	ISPA North America Cup	3 Rounds US$ 35.00 for ISPA members US$ 30,00
June 25^th & 26^th	North American Championship	5 Rounds US$110.00 for ISPA members US$ 100.00
June 26^th	Zocker Tournament	2 Rounds US$55.00 for ISPA members US$ 50.00
June 27^th	ISPA USA Cup	3 Rounds US$ 35.00 for ISPA members US$ 30.00
June 28^th	ISPA USA Grand Prize	3 Rounds US$ 35.00 for ISPA members US$ 30.00

I’M ALSO PLAYING IN THE CHALLENGE CUP

Note: To participate in the Challenge Cup you have to qualify with your average score for the past year.

You will be notified and invited by one of the ISPA Canada/USA Vice Presidents ahead of time.

       Yes   (or)    No

June 24^th & 25^th

Challenge Cup