Club Registration USA 2021 - Student Programs
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1.
Question - Required -
School Name
2.
Question - Not Required -
Club Name (if applicable)
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3.
Question - Required -
School Street Address
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4.
Question - Required -
School City
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5.
Question - Required -
School State
Please select response
AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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6.
Question - Required -
School Zip Code
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7.
Question - Required -
School Type:
Please select response
Elementary/Grade
Lower/Middle
High School
University
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8.
Question - Required -
Advisor/Moderator/Teacher Name
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9.
Question - Required -
Advisor/Moderator/Teacher Email
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10.
Question - Required -
Advisor/Moderator/Teacher Phone Number
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11.
Question - Required -
Primary Student Contact Name
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12.
Question - Required -
Primary Student Contact Email
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13.
Question - Required -
Primary Student Contact Phone Number
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14.
Question - Required -
Primary Student Contact Graduation Year (ex: 2020)
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15.
Question - Required -
Secondary Student Contact Name
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16.
Question - Required -
Secondary Student Contact Email
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17.
Question - Required -
Secondary Student Contact Phone Number
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18.
Question - Required -
Secondary Student Contact Graduation Year (ex: 2020)
19.
Question - Not Required -
School Website
20.
Question - Not Required -
Club Instagram Page
21.
Question - Not Required -
Club Facebook Page
22.
Question - Not Required -
Other Club Social Media Handle(s)
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23.
Question - Required -
In what month does your school year start?
Please select response
January
February
March
April
May
June
July
August
September
October
November
December
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24.
Question - Required -
Are you registering a new club?
Please select response
Yes
No
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25.
Question - Required -
Approximate Number of Club Members
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