MCC Trivia Night November 2009 Registration Form

MCC Trivia Night Registration Form (November 6th, 2009)

Thank you for taking a few minutes to register for the MCC Trivia Night 2009 - your registration information will assist us in creating an organized, enjoyable evening for all participants!

1. Your Contact Information (person completing Registration Form):

Your Contact Information (person completing Registration Form): Your Name
Your E-mail address
Your Phone#

2. I am registering as a:

I am registering as a: Team (4-8 people)

Free Agent (individual with no team members)

3. Registration Fees are required for registered Teams and registered Free Agents - please select the option that applies to you or your team. Registration fees (cash or check) will be collected only the night of the event.

Registration Fees are required for registered Teams and registered Free Agents - please select the option that applies to you or your team. Registration fees (cash or check) will be collected only the night of the event. TEAM - $40 registration fee

FREE AGENT - $5 registration fee

4. Team Name (REQUIRED, unless registering as a free agent):

Team Name (REQUIRED, unless registering as a free agent):

5. Total number of team members:

Total number of team members: 4

N/A (applies only to individuals registered as "free agents")

6. Team Member Names (REQUIRED, unless registering as a free agent):

Team Member Names (REQUIRED, unless registering as a free agent): Member #1
Member #2
Member #3
Member #4
Member #5
Member #6
Member #7
Member #8

7. Team Leader (and free agent) Contact Information:

Team Leader (and free agent) Contact Information: Team Leader Name
Team leader E-mail
Team Leader Phone#

8. Would your team be willing to accept a "free agent" participant (an individual who doesn't have a team of their own) if necessary?

Would your team be willing to accept a "free agent" participant (an individual who doesn't have a team of their own) if necessary? YES

N/A (applies only to individuals registered as "free agents")

9. Questions, Comments, or Special Requests? Please enter text here, or contact Jonathan Crockett at crockettj@middlesex.mass.edu, or (781) 280-3785.

Questions, Comments, or Special Requests? Please enter text here, or contact Jonathan Crockett at crockettj@middlesex.mass.edu, or (781) 280-3785.

Thank you for your Registration! We look forward to your participation at MCC Trivia Night 2009!