Membership Registration

2016 – 2017 Membership Application (pdf version) 
 School Name
 School type
 Grade Levels (Ex. K-6, 6-8, K-12)
Membership # optional
Is it an additional membership?
Is this a residence address?
Shipping Address for membership package, please use street address for UPS delivery.
 Street 2
 City, State, Zip  ,  , Please use state abbreviation. ( e.g. NY, PA )
Do you want to purchase an additional membership such as
Team B, Team C ?

  Mailing Information for Newsletter  

 First Name
 Last Name
 Day time phone#
 Home Phone
 Street 2
 City, State, Zip  ,  ,  Please use state abbreviation. ( e.g. NY, PA )


 Credit Card Type
 Credit Card Number
 CVV code What is the CVV Code?
 Expiration Date /
 Card Holder Name