Please complete this entire form to register your Team Manager, Team Members, Appraiser, and Payment information. If you have any questions about this form, please contact Jill Granger at jgranger@charter.net
Membership number: 129-
Membership name:
Region: Select One 1 2 3 4 5
School district:
Challenge: Select One Challenge A: Operation Cooperation Challenge B: Instinct Messaging Challenge C: ViDIo Lit Hits Challenge D: Private DI Challenge E: A New Angle! Challenge F: Project Outreach Rising Stars: Hidden!
Level: Select One Rising Stars! Elementary Middle Secondary University
First Name:
Last Name:
Mailing address line 1:
Mailing address line 2:
City:
State: KS NE
Zip:
Work phone:
Home phone:
Email:
Experienced? Yes No
Area Appraised: Select One Central Challenge Instant Challenge Score Room
Child involved? Yes No
If child involved, which challenge? Select One Challenge A: Operation Cooperation Challenge B: Instinct Messaging Challenge C: ViDIo Lit Hits Challenge D: Private DI Challenge E: A New Angle! Challenge F: Project Outreach Rising Stars: Hidden!
First name:
Last name:
Grade level: Select a Grade k 1 2 3 4 5 6 7 8 9 10 11 12 Higher Ed
Grade level: Select a Grade k 1 2 3 4 5 6 7 8 9 10 11 12Higher Ed
Purchase Order Check Money Order
Please make payments to:
N-CAPS Jill Granger 1120 Sherman Court North Platte, NE 69101
NOTE: If paying with a Purchase Order you will need to add 15% to the total fees.
