Saturday, September 8, 2012, 11:30am to 4:00pm
CSU East Bay Conference Center
1000 Broadway, Suite 109
Oakland, California 94607
City, State, ZIP: _________________________________________________
Will you be ______ under age 18 or ______ over age 65 at the time of the tournament?
Have you competed in any crossword tournament before? Yes / No
Do you have a physical limitation that might require special accommodation? If so, please briefly describe what accommodation you require.
Please check here ____ if you do NOT want to join the Families of SMA email list
Please check here ____ if you do NOT want to join the tournament Yahoo! group/email list (http://games.groups.yahoo.com/group/westcoastcrosswordtournament/).
The registration fee is $25 if postmarked by June 30, $30 if postmarked July 1 or later, or $35 if you register the morning of the event. Additional tax-deductible donations to Families of SMA are most gratefully accepted and can be added to your registration fee at your discretion, on the same check. If you register at the event, please complete this form and bring it with you to save time.
Families of SMA is a 501(c)(3) registered charity, so your registration fee may be fully or partially tax-deductible. Check with your tax adviser to be sure.
Please make checks payable to Families of SMA and mail this form and your check to:
Andrew Laurence, 2709 Calhoun St., Alameda, CA 94501
If you have any questions, email email@example.com or call 510-681-9675.