2017 MN DI Affiliate Tournament Registration Form
Please submit ONE registration per team. Note that teams performing in two challenges will have to submit separate registration forms. After submitting form, please send affiliate tournament fee ($175 per team, payable to Intermediate District 287) by March 28, 2017 to:

Intermediate District 287
Attn: Kim Kallroos
1820 Xenium Lane N
Plymouth MN 55441

**Please note that only scheduling requests for team managers with multiple teams will be accepted.
***Please indicate if a team is participating in more that one Challenge OR if a team member is part of more than one team.

VERY IMPORTANT: Due to a number of expensive infractions at last year's event, absolutely NO food or beverages can be brought into Jackson Middle School. This includes bottled water. There will be a variety of breakfast, lunch and snack items available all day in the Jaguar Cafeteria, but any food or drink must be consumed in the Cafeteria. Nothing may be taken out of the Cafeteria into the hallways or other rooms in the school.

Teams may have food outside if weather permits, or go to one of the local restaurants if they prefer instead of enjoying the Jackson Middle School menu.

If any food or beverage is found in storage rooms, teams in that room will be fined and immediately lose access to the room. If there is damage to the room or its contents, all teams will be fined and dismissed from the tournament.

We know this may be challenging, but the damage and costs for cleaning and repairs last season was extensive. Further incidents will prohibit us from holding future tournaments in these schools. For this reason, we will also be offering alternatives to storage rooms. Please attend to the storage room options and select below.

Thank you for your help in making this a positive experience for everyone!

Membership Name (school or program name)
Your answer
Membership Number (ex. 123-00000)
Your answer
Team Nickname
Your answer
School District
Your answer
Region
Team Manager:
Release/Disclaimer By my participation in an event conducted by an Affiliate, Region or other gathering related to the Destination Imagination program, the participant or participant's parents or participant's guardian understands and hereby voluntarily agrees to release, waive, forever discharge, hold harmless, defend and indemnify Destination Imagination, Inc., and their agents, officers, boards, volunteers, and employees from any and all liability and all claims, actions, or losses for bodily injury, property damage, wrongful death, loss of services, or otherwise which may arise out of the participant's participation in activities related to the Destination Imagination event, including travel to and from the event.
Team Manager Name
Your answer
Team Manager Email
Your answer
Team Manager Cell Phone #
Your answer
Team Manager Street Address
Your answer
Team Manager City
Your answer
Team Manager Zip Code
Your answer
Please indicate if you manage more that one team or if a team will perform in multiple challenges. Indicate team number, challenge and level.
Your answer
Challenge
Level
Team Storage Options - please select one
DI Coordinator Name
Your answer
DI Coordinator Email
Your answer
DI Coordinator Cell Phone #
Your answer
Volunteer Information
Each team is asked to provide ONE tournament volunteer (volunteer no shows will be assessed a 10 point penalty).
Volunteer Name
Your answer
Volunteer Email
Your answer
Volunteer Cell Phone #
Your answer
Volunteer Street Address
Your answer
Volunteer City
Your answer
Volunteer Zip Code
Your answer
Media Release
Sanctioned tournament officials and media representatives will be filming/photographing participants and spectators throughout the day. Please notify all team parent/guardians. MN DI will be using photographs and video clips for marketing purposes, including websites. If you have team members who prefer not to have their pictures used, please indicate their names here.
List team members who do not want their photo used for media purposes:
Your answer
Please list names and schools of high school seniors, so they can be recognized in our affiliate tournament program book.
Your answer
Global Finals:
If your team advances to Global Finals, payment is due on May 3. For details on pricing, see www.globalfinals.org. In order to have shirts ready for our Global Finals Team Manager Meeting on April 27, please give us your Team Manager and team member shirt sizes. Options: Youth Medium, Youth Large, Adult Small, Adult Large, Adult X-Large, Adult 2X, Adult 3X.
Please provide t-shirt sizes below:
Your answer
Payment
If you want a copy of your registration, please print before submitting this form. Please send tournament fee ($175 per team payable to Intermediate District 287) to Kim Kallroos at the address below. There are no refunds. Sorry we do not accept credit card payment.

Intermediate District 287
1820 Xenium Lane N
Plymouth MN 55441

Questions? Contact Kim at 763-550-7245 or kkkallroos@district287.org.

Thank you!

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