Membership/Passport Name: _____________________________ DI Passport Membership Number: _______________________ Team Challenge ________________________________ Level___________

Instant Challenge/Improv Day Registration Form
sponsored by Destination ImagiNation of Kentucky - DI-KY

Print Name	Adult or Child?
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**** NOTE EVERY TEAM MUST bring one adult who will run an IC room all day ****
AND bring 12 copies of an IC AND materials for 12 teams to do the challenge.
TOTAL DUE: Number of Team Members attending x $4 each (or $25 for whole team) $_______
Make checks payable to Destination Imagination of Kentucky

Adults are FREE!!! MINIMUM of 1 adult per 3 students REQUIRED!

AT LEAST A WEEK IN ADVANCE - PLEASE mail this form and payment to Peggy Middendorf, 3817 Raymonde Lane, Erlanger, KY 41018
Make checks payable to Destination Imagination of Kentucky