Registration Form

Print out this form, fill it in, and mail, with a check or money order, to: American Crossword Puzzle Tournament, 55 Great Oak Lane, Pleasantville, NY 10570.

Total enclosed: $_______________________________

About You:

Name	__________________________________________
Address	__________________________________________
	__________________________________________
Phone	__________________________________________
Occupation	__________________________________________
E-mail	__________________________________________ NOTE: E-mail to be used only for tournament purposes — the ACPT does not sell, rent, or give e-mail addresses to anyone else

Rates per person:

	All Events as a Competitor (including Friday)	$255*
	All Events as a Non-Competitor (including Friday)	$210*
	All Events as a Competitor (beginning Saturday morning)	$180*
	All Events as a Non-Competitor (beginning Saturday morning)	$135*
	Friday Evening Games and Reception Only	$  80
	Spectator for Sunday Playoffs (starting at 11AM) Only	$  30

*You may deduct $10 from this amount if payment is made and received by March 5, 2013.

Check one if applicable:

Junior (25 years or under)
Fifties (50-59)
Sixties (60-69)
Seventies (70-79)
Senior (80 or over)


Birthdate required for all age events:

____/ Month

____/ Day

____ Year

Check one of the following [map]:

Connecticut
Other New England
New York City
Long Island
Westchester/Upstate New York
New Jersey
Other Mid-Atlantic
South
Midwest
West
Canada/Foreign

Check if applicable:

Rookie (never attended the ACPT in person)

All registrations must be accompanied with full payment. (Full refund until 48 hours prior.) For rates for attendance not covered above, please call or write.

Please make room reservations directly with the Marriott. See Program for details.