State Tournament Team Registration, Data & T-shirt Order Form

team_t-shirt_orders_and_data_for_state.xlsx
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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 *

Challenge Name (Select One) *

Age Level (Select One) *

Passport (Membership) Number *

TM First Name *

TM Last Name *

TM Email *

TM Cell Phone Number *

TM 2 First Name *

TM2 Last Name *

TM2 Email *

TM2 Cell Phone Number *

Address *

City *

State *

ZIP *

Once you have the totals, enter them here:

Youth S *

Youth M *

Youth L *

Adult Small *

Adult Med *

Adult Large *

Adult XL *

Adult 2X *

Adult 3X *

T-Shirt Total Cost *

Attending Super Saturday *

Yes No

Total Cost *

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

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