2018 – 2019 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.
*A $20 fee will be charged for address changes after package is shipped.
Street
Street 2
City, State, Zip  ,  , 

Please use state abbreviation. ( e.g. NY, PA )

District
County
Country
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
Fax
Email
Street
Street 2
City, State, Zip  ,  , 

Please use state abbreviation. ( e.g. NY, PA )

Country

 

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

   Items in BOLD are required fields.