Team Registration Form

Address all questions to:
Steve Cormier
Wisconsin DI Affiliate Director
(920) 465-9646

• No registrations will be accepted after 2/11/2012.
• Team Appraiser information must be completed on or before 2/11/2012
• You may register more than one team during this session, provided they are from the same region. (They will be billed together on one statement). Please identify below how many teams you are registering now, and the region the teams are from. (Note: Please register teams participating in Project Outreach in a separate session.)
• If you are registering teams from more than one region, please complete the registration process for the teams from one region, and then return to this page to begin teams from the next region.

In order to complete this registration form, please have all of the information below available for each team you are registering:

• Team Number
• Team Name
• Challenge the team is competing in
• Team manager name and contact information.
• Team member names
• Team member ages (as of 6/15/2012) OR current grade levels (Entire team must be registered using one or the other)
• The school each team member attends.
• Number of graduating seniors on the team, if any
• Team members (and/or manager) disabilities or conflicts
• If you have an appraiser, their name and contact information. (You can provide this after registration if not available now.)
• Payment information: credit card (available for some regions) or check. (Your team will not be scheduled until payment is received)

Please verify your registration before clicking the final submit button

• Check to be sure your team is registered in the correct age/grade level.
• Check to be sure your team is registered in the correct challenge.
• Check to be sure your team is registered for the correct tournament

If you provide an email address below, upon receipt of your Team Registration you will receive a confirmation email . Check your confirmation to be sure all registration information is correct. Please contact your Regional Director with any problems or questions.

Each team to be registered will have a team number starting with “148”. Each team registered should have a 5 digit number following the “148” that designates your team. (Example: 148-12345) Your team number identifies your team throughout the competition.

Disclaimer
By my participation in an event conducted by an Affiliate, Region or other gathering related to the Destination imagination program, the participant or participant's parents or participant's guardian understands and hereby voluntarily agrees to release, waive, forever discharge, hold harmless, defend and indemnify Destination Imagination Inc., and their agents, officers, boards, volunteers, and employees from any and all liability and all claims, actions, or losses for bodily injury, property damage, wrongful death, loss of services , or otherwise which may arise out of the participant's participation in activities related to the Destination Imagination event, including travel to and from the event.