Destination ImagiNation of New York
2000-2001 REGISTRATION FORM
One state membership must
be purchased for each national membership in order to compete at any level.
National (and state) memberships are defined according to the following categories.
A. Individual Schools: Public, private, parochial or
chartered school
B. Small School District
or Multiple school campus: total enrollment of 500 students or less
C. Certified Home School
Program
D. Community
Organization: Non-profit
organizations or groups that sponsor education activities for youth.
E.
University/College/Military
Please check the National
Membership Form for the definition of competitive levels.
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Complete one form for each
membership copy this form as needed:
School
District:________________________________________________________________________
Membership
Category:__________________________ Grades in Building________________________
Membership Name:____________________________________________________________________
Address:_____________________________________________________________________________
City_______________________________________________________Zip
code:__________________
County___________________________
Region (check one) ÿ EAST ÿ
CENTRAL ÿ WEST
National Passport
#___________________ if you don't have this yet, don't wait for it!
Contact
Person:_______________________________________________________________________
Work phone: _____________________________
Home phone:_________________________________
E-mail
address:_______________________________________________________________________
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A check for $45.00 per membership should be made payable to "Destination
ImagiNation of New York" and is due by January 15, 2001. No memberships
will be accepted or processed after February 15, 2001.
Mail to:
Dee Urban, Affiliate Director
Destination ImagiNation
of New York
73 Minden Drive
Orchard Park, New York
14127