Northmont Academic Challenge Tournament

Northmont Academic Challenge Registration

Saturday, January 16, 2010

Please provide the following registration/contact information: Print two copies of the registration form before submitting electronic registration - one for your records and one to be included with your payment.

Today's Date -- mm/dd/yy

Coach's First Name

Coach's Last Name

Title

School

Street Address

Address (cont:)

City

State/Province

Zip/Postal Code

Work Phone

Cell Phone (contact day of event)

FAX

E-mail

Provide the following team information.

Please note: Discounts available for teams providing a buzzer system ($10 for providing a buzzer system, one discount per registered team, maximum 2 system discounts per completed school registration)

Team DESCRIPTION Fee
Providing a buzzer system?
Discount

Academic Team A $60 Yes -$10

Academic Team B $50 Yes -$10

Academic Team C $50 Yes -$10

When submitting rosters, submit your best team as Team A, second best as Team B, etc.

Academic Team A Roster

Academic Team B Roster

Team Captain: Team Captain:

2: 2:

3: 3:

4: 4:

Alternate 1: Alternate 1:

Alternate 2: Alternate 2:

Alternate 3: Alternate 3:

Alternate 4: Alternate 4:

Academic Team C Roster

Team Captain:

2:

3:

4:

Alternate 1:

Alternate 2:

Alternate 3:

Alternate 4:

BILLING

Purchase Order # (Optional)

or Check # (Optional) Make checks payable to Northmont High School

Make checks payable to:
Northmont High School
Submit payment to:
David Jones
Northmont High School
4916 National Road
Clayton, Ohio 45315

3640 Colonel Glenn Highway - Dayton, Ohio - 45435

Coach's First Name
Coach's Last Name
Title
School
Street Address
Address (cont:)
City
State/Province
Zip/Postal Code
Work Phone
Cell Phone (contact day of event)
FAX
E-mail

Team	DESCRIPTION	Fee	Providing a buzzer system?	Discount
	Academic Team A	$60	Yes	-$10
	Academic Team B	$50	Yes	-$10
	Academic Team C	$50	Yes	-$10

Academic Team A Roster		Academic Team B Roster
Team Captain:		Team Captain:
2:		2:
3:		3:
4:		4:
Alternate 1:		Alternate 1:
Alternate 2:		Alternate 2:
Alternate 3:		Alternate 3:
Alternate 4:		Alternate 4:

Academic Team C Roster
Team Captain:
2:
3:
4:
Alternate 1:
Alternate 2:
Alternate 3:
Alternate 4:

BILLING
Purchase Order # (Optional)
or Check # (Optional)		Make checks payable to Northmont High School