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State Tournament Team Registration & T-shirt Order Form
This form and T-shirt payments are due for each team on Saturday, Jan 23, 2016.
You may submit this form on-line and bring payment to Super Instant Challenge Saturday, or mail payment to Nancy Farley, J.S. Clark Magnet School, 1207 Washington Street, Monroe, LA 71201.
Don't forget to order for parents & supporters too!
Please use normal capitalization, i.e., no ALLCAPS HIGH or e.e.cummings elementary, please.
*
Indicates required field
School Name
*
Do not include "School" as part of your school's name. E.g., "Howard Elementary," or "Bart Simpson High." Please make sure you use the same exact spelling/wording for all the teams at your school--thank you :)
Challenge Name (Select One)
*
Technical - Pace of Change
Scientific - In Plain Sight
Structural - Musical Mashup
Fine Arts - Get a Clue
Improvisational - Close Encounters
Service Learning - The Meme Event
Early Learning - Change in Direction
Age Level (Select One)
*
Early Learning/Rising Stars (Ages 4-7)
Elementary (Grades 3-5)
Middle (Grades 6-8)
Secondary (Grades 9-12)
University
Passport (Membership) Number
*
You must have registered with Destination Imagination, Inc., through shopdi.org in order to have a DI Membership Number.
Team Manager (TM) First Name
*
TM Last Name
*
TM Email
*
TM Cell Phone Number
*
Enter the best phone number for contacting your school's primary LA DI point of contact after school/during evening hours.
T-shirt Size
*
YS
YM
LT
S
M
L
XL
2X
3X
Team Manager 2 First Name
*
1 Team Member First Name
*
TM2 Last Name
*
Last Name
*
TM2 Email
*
Age
*
TM2 Cell Phone Number
*
T-shirt Size
*
Option 1
Option 2
Option 3
Louisiana State Tournament T-shirt Orders
Enter number needed for each size and calculate cost for each size
Youth Small
*
Enter the number of Youth Small Size T-Shirts needed.
x $15 =
Total $ for Y Small
*
Multiply the number of Youth Small T-Shirts times $15 and enter it in this field.
Youth Medium
*
Enter the number of Youth Medium Size T-Shirts needed.
x $15 =
Total $ for Y Medium
*
Multiply the number of Youth MediumT-Shirts times $15 and enter it in this field.
Youth Large
*
Enter the number of Youth Large Size T-Shirts needed.
x $15 =
Total $ for Y Large
*
Multiply the number of Youth Large T-Shirts times $15 and enter it in this field.
Adult Small
*
Enter the number of Adult Small Size T-Shirts needed.
x $15 =
Total $ for Adult Small
*
Multiply the number of Adult Small T-Shirts times $15 and enter it in this field.
Adult Medium
*
Enter the number of Adult Medium Size T-Shirts needed.
x $15 =
Total $ for Adult Medium
*
Multiply the number of Adult Medium T-Shirts times $15 and enter it in this field.
Adult Large
*
Enter the number of Adult Large Size T-Shirts needed.
x $15 =
Total $ for Adult Large
*
Multiply the number of Adult Large T-Shirts times $15 and enter it in this field.
Adult XL
*
Enter the number of Adult XL Size T-Shirts needed.
x $15 =
Total $ for Adult XL
*
Multiply the number of Adult XL T-Shirts times $15 and enter it in this field.
Adult 2XL
*
Enter the number of Adult 2XL Size T-Shirts needed.
x
$17
=
Total $ for Adult 2XL
*
Multiply the number of Adult 2XL T-Shirts times $16 and enter it in this field.
Adult 3XL
*
Enter the number of Adult 3XL Size T-Shirts needed.
x
$16
=
Total $ for Adult 3XL
*
Multiply the number of Adult 3XL T-Shirts times $16 and enter it in this field.
T-Shirt Total Cost
*
Add all the amounts for each size T-shirt size.
Orders and payments are due NLT
Saturday, Jan 23, 2016
.
Make checks out to LA DI
Mail or deliver checks to:
Nancy Farley
J.S. Clark Magnet School
1207 Washington Street
Monroe, LA 71201
Print this page for your records
prior to submitting
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