First Name:*

Last Name:*

Contact Email:*

Day Phone:*

Evening Phone:*

Gender* Select One Male Female

Birthmonth: (you must enter six characters in this format - mmyyyy - month and year only)*

Which week would you like to register for?* Select One June 17 June 24 July 15 July 22

Which session do you want to register for?* Select One Morning (9 a.m. - noon) Afternoon (1 - 4 p.m.)

Do you want to purchase an extended playing session? (This allows for a camper to be dropped off an hour early or picked up an hour late. The fee is $75.00 for extended play. Being late will still warrant an extra charge.)* No Morning (7:30 - 9 a.m.) Afternoon (4 - 5:30 p.m.)

You may be eligible for a small discount. Choose one of the following if they apply to you:* No Discount UT Dallas Faculty, Staff and Student - $25 discount UT Dallas Alumni Association Member - $25 discount Families with two or more children enrolled - $25 per child Education discount for teachers - $50 discount

What is the camper's t-shirt size?* Select One Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

How did you hear about us?* Select One Dallas Child UT Dallas Brochures Plano Profile Chess Program Email Dallas Morning News Epoch Times Friend Suburban Parent Other

Address:*

City:*

State:* Select a State Not Applicable Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Flordia Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:*