2012 State Tournament
Registration

March 16-17, 2012

Grace Assembly of God
New Whiteland
 
Church address
6822 N. US Highway 31
New Whiteland, IN 46184

Phone Number: (317) 535-5640

Website: http://www.grace-assembly.org

 Registration Deadline: March 3, 2012

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Please fill in the following information and select the "Submit" button at the bottom of the form.  Then send your check for the registration fee to the address listed below.

Please submit a separate form for each team you wish to register.

Church:
City:
Phone:
Email Address:
Coach:
Assistant Coach:

 

Division:

Searcher       Discover

 

Names and qualifications of two officials representing your team (check all that apply):
	QM  J  TK    SK          [Over 21? Yes  No]
	QM  J  TK    SK          [Over 21? Yes No]

    

	Team Name:
	Names of Quizzers:	Awards Quizzer has received this year:
1.
2.
3.
4.
5.
6.
7.
8.

 

Lunch
$4.00 for 1-slice pizza, chips, cookie, drink
$5.00 for 2-slices pizza, chips, cookie, drink

Total number of meals needed: 

 Registration Fee:    $40 per team  (by March 3, 2012)
Late Registration Fee:    $50 per team                                

Please send your check (payable to First Assembly of God - Fort Wayne) to:

Pastor Barry Jorris
First Assembly of God
1400 West Washington Center Road
Fort Wayne, IN 46825

Additional Comments

Validation Question

Is fire hot or cold? (Enter "hot")

 

You must press the "Submit" button below to complete your registration.
After Submitting form, print out the confirmation page and send a copy with your payment.

 

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For further information, contact Barry Jorris at:

Phone:  (260) 490-8585         E-mail:  kidsrap@juno.com

[Last updated on Saturday, July 30, 2011]  

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