Name (Last, First, MI)*:

Rank (By Name, i.e., Captain)*:

Email Address*:

Military Address (Organization, Unit, State, P.O., APO, and Zip Code):

Major Army Command (MACOM)*:

Duty Telephone No. (Autovon/Commercial)*:

Record of Significant Chess Activity During the Last Two Years
(Please list Date, Place, Event, & Standing Place):

U.S. Chess Federation Membership Card Identification Number & State of Registration:

U.S. Chess Federation Rating:

Date of Rating:

Date & Location of Last U.S. Chess Federation Tournament:

I Did Did not participate in an installation qualifying tournament.

Installation Identification (if applicable)

I Did Did not participate in a MACOM qualifying tournament.

MACOM Identification (if applicable)

Current Duty Assignment (Clerk, Medic, etc.)*: