2009-2010
Minnesota DI Regional Tournament
Team Registration
and Media Release Form
After submitting form,
please send Tournament fee (payable to District 287)
by 1/8/10 to:
Kim Kallroos
Intermediate District 287
1820 Xenium Lane North
Plymouth, MN 55441
The information on this form will be used to schedule the team for the Regional Tournament. You will find your tournament assignment and fee at www.mndi.org.

Note: Please use the TAB key to navigate this form. The ENTER key will submit your form.
Print before submitting for your records.

Team Information

Team Name: Team #:

Team Nickname (22 characters max):

Region:

District:

Team Contact:

Address:

City: Zip:

Phone: Email:

Do you want a Team Storage Room? (yes or no) :

Challenge:
 Level:

Please note the following:

Rising Stars! (K-2nd grade)

Elementary Level (3-5th grade) OR No member age 12 by 6/15/10

Middle Level (6th-8th grade) OR No member age 15 by 6/15/10

Secondary Level (9th-12th grade) OR no member age 19 by 6/15/10
Team Manager Information
Team Manager
Phone Number
E-mail
Volunteer Information: Each team is asked to provide ONE Tournament Volunteer. (Volunteer no shows will be assessed a 10 point penalty).

Name: Phone:

Email:

Address:

City: Zip:

Special Considerations:
Please include information such as a Team Manager with more than one team (list additional team information), a team member or Manager with physical disability, or alternate language preferences other than English.

Media Release:
Sanctioned tournament officials and media representatives will be filming/photographing participants and spectators throughout the day. Please notify all team parents/guardians. MN DI will be using photographs and video clips for marketing purposes, including web sites.

If you have any team members who prefer not to have their pictures used, please indicate their names here:
If this is your first year, how did you hear about Destination ImagiNation?

Before submitting registration form, please print a copy for your records.
Submit only once.

After submitting form, please send Tournament fee (payable to District 287) by 1/8/10 to:
Kim Kallroos
Intermediate District 287
1820 Xenium Lane North
Plymouth, MN 55441
If you have other questions, please email Kim at kkkallroos@district287.org. Or call Kim at 763.550.7245