Iowa Membership Registration Form

Iowa Destination Imagination®

administered by Students for a Creative Iowa

Welcome to the 2012-13 season of Destination Imagination® in Iowa! Students for a Creative Iowa is looking forward to a great new year as we already have plenty of new improvements for this season. Please review the following form and terms and conditions in order to register your team for an Iowa membership.

The 2012-13 Early Bird Registration Deadline: January 14, 2013

Registrations received by January 14, 2013 pay the Early Bird registration fee as follows:

-$65.00 per each competitive team

-$45.00 per each non-competitive team

The 2012-13 Final Registration Deadline: January 21, 2013

Registrations received after January 14, 2013 and by January 21, 2013 pay the Final registration fee as follows:

-$85.00 per each competitive team

-$65.00 per each non-competitive team

Sub-state Tournament: March 9th 2013

State Tournament: April 6th 2013

Submission: send yourcomplete registration form to by the above deadlines.

Please note that in an effort to be more effective for our members and to be more environmentally friendly, Students for a Creative Iowa is requiring ALL registrations to be submitted electronically.All incomplete forms (see definition of “complete registration” in terms and conditions) will be returned or rejected, causing a delay in registration which may lead to a missed deadline. To qualify for the Early Bird Registration fees, you must electronically submit your Iowa membership registration form by January 14, 2013.

For more instructions on submitting your registration form electronically, please check out the provided “How To” guide.

Please note that purchase of the Destination Imagination Program is required to complete this form. Please go to for more information on how to purchase your DI Team Pack(s).

If you have any questions or concerns, please contact us:

Iowa Membership Team Information

Affiliated School or Organization Name:
Team Name:
DI Team Number: / 112-

Coordinator/DI Contact Information

Name:
Affiliated School or Organization Name:
Street Address:
City, State, Zip:
Email*:
Phone (Day):
Phone (Evening):
Fax:

Team Manager Information (please note, usually different than Coordinator/Purchaser)

Name:
Affiliated School or Organization Name:
Street Address:
City, State, Zip:
Email*:
Phone (Day):
Phone (Evening):
Fax:

*Please provide an accurate email addressthat is checked regularly as majority of our communications occur via email. The email should be associated with a Google Account in order to access cre8iowa Member-only content.

We plan on participating as:(choose one)

Competitive team and receiving a score at tournament(s) for our solution

Non-competitive team and presenting our solution at tournament(s) without score

Non-competitive team and will not present our solution at tournament(s)

Our team is participating at the following Level: (choose one)

EL (Elementary) ML (Middle) SL (Secondary) C&UL (University)

Our team has chosen its Level using:Grade Level Age

Our team is participating in the following Challenge: (choose one)

Challenge A: In the Zone Challenge D: Change in RealiTee

Challenge B: Wind Visible Challenge E: Twist-O-Rama

Challenge C: In Disguise projectOUTREACH®: Reel to Real(State tournament)

Rising Stars!®: ROY G BIV (Sub-state tournament)

Iowa Team Members List

DI Team Number: / 112-
Name / Grade / Date of Birth / Competing on other teams? / Other Team Numbers
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-
Yes No / 112-
112-

Accommodation or Special Scheduling Request

All requests should be specific and must be submitted to t least 3 weeks prior to the tournament for which you are requesting accommodations.

Students for a Creative Iowa will do its best to meet the needs of its participants.

Sub-State Scheduling Request:
State Scheduling Request:
Special Needs Accommodation:

Appraiser Registration

Team Information (to be filled out by team for Appraiser)

Affiliated School or Organization Name:
Team Name:
DI Team Number: / 112-

Appraiser Contact Information(to be filled out by Appraiser)

Name:
Email*:
Phone (Day):
Phone (Evening):
Prior DI Experience: / Appraiser: Yrs / Team Mgr: Yrs / Team Mbr: Yrs / Other: Yrs

*Please provide an accurate emailaddressfor the Appraiser that is checked regularly as majority of the communications between Challenge Masters and Appraisers occur via email.

Conflicts of Interest

A: In the Zone EL ML SLC&UL

B: Wind Visible EL ML SLC&UL

C: In Disguise EL ML SL C&UL

D: Change in RealiTee EL ML SL C&UL

E: Twist-O-Rama EL ML SL C&UL

projectOUTREACH® EL ML SLC&UL

Appraiser Training Information (to be completedin person at Training)

Please allow enough time for check-in at Appraiser training at which time you will turn in completed paperwork and make your final Challenge selection. Check-in begins at 9:00 a.m. and training runs from 10:00 a.m. to 3:00 p.m. You may purchase lunch on-site for $6 or bring your own sack lunch. There will not be an opportunity to leave the site for lunch. For more information, please go to

Challenge Trained In:

Challenge A: In the Zone Challenge D: Change in RealiTee

Challenge B: Wind Visible Challenge E: Twist-O-Rama

Challenge C: In DisguiseInstant Challenge

Position Trained In:

Appraiser Team Organizer Head Appraiser Timekeeper/Announcer

Prep Area Appraiser Team Challenge Appraiser Check-In Appraiser

Challenge E Only: Weight Placement

Where Trained:

Carroll Iowa City Ames

I agree to represent the above team and I verify that I understand that for the team I represent to perform at the Sub-state and State tournaments I must appraise at both tournaments.

Signature: ______Date:______

Rising Stars!® Volunteer Registration

Team Information (to be filled out by team for Volunteer)

Affiliated School or Organization Name:
Team Name:
DI Team Number: / 112-

Volunteer Contact Information

Name:
Email*:
Phone (Day):
Phone (Evening):
Prior DI Experience: / Appraiser: Yrs / Team Mgr: Yrs / Team Mbr: Yrs / Other: Yrs

*Please provide an accurate email addressfor the volunteer that is checked regularly as majority of the communications between the RS Volunteer Coordinator and volunteers occur via email.

I agree to represent the above team and I verify that I understand that for the team I represent to perform at the Sub-state tournament, I must workone shift as a Tournament Official at the Sub-statetournament.

Electronic Signature: Date:

Iowa Membership Payment and Acceptance

Affiliated School or Organization Name:
Team Name:
DI Team Number: / 112-

Payment Method (please select one)

A copy or scan of the payment must accompany this registration form if paying by check or purchase order. Please contact if you require information on where to mail or fax payment only information. If paying electronically, the confirmation number listed in the field below should be sufficient.

Check #

Purchase Order #

Electronic Payment Conf#

Billing Contact information(if different than Coordinator)

Name:
Affiliated School or Organization Name:
Street Address:
City, State, Zip:
Email:
Phone:
Fax:

DI Release/Disclaimer

By my participation in an event conducted by an Affiliate, Region or other gathering related to the DestinationImagination® 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 DestinationImagination event, including travel to and from the event.

Required.On behalf of the DI Team #112-, I verify that I understand and agree to the terms and conditions of the Iowa Membership,including the Appraiser/volunteer requirement, and agree to adhere to all Tournament Policies.

Optional.On behalf of the DI Team #112-, I hereby consent that photographs, audio recordings, and videos taken of my team during tournaments may be used by cre8iowa for purposes of event documentation, media coverage, and promotion of creative problem solving. Names of students will not be published.

Electronic Signature:

*Should be signed by Team Manager or Coordinator

Terms and Conditions

Definitions
“Iowa Membership” includes supportsuch as the blog, email, and website, cre8iowa member-only content, a Basic Training Podcast for Team Managers & Coordinators, an Advanced Training Workshop for Team Managers & Coordinators, Appraiser Training and participation at Iowa tournaments.
“DI Team Number” means the DI registration number a team receives upon purchase of the Destination Imagination Program Materials, for example 112- XXXXX. This is required to purchase an Iowa Membership.
“Competitive team” means any Elementary, Middle, Secondary Level, or College & University Level team that chooses to participate at an Iowa tournament for score.
“Non-competitive team” means Early Learners (Rising Stars!®) and those elementary, middle, secondary, or college & university teams that choose to participate at an Iowa tournament without being scored OR a team that wishes to participate with Iowa training and support opportunities without participating at tournament.
“Completed registration” means that all fields in the Iowa Membership Registration form are filled. Fields are to be filled out by typing the appropriate and accurate information. Note: handwritten entries are not accepted as a completed form.
Submission
A registration form needs to be filled out for each DI Team Number being used. When saving this form, please include the DI Team Number in the file name.
Submit registration form and copy of payment via email to .
All incomplete forms (see definition of “complete registration” above) will be returned or rejected, causing a delay in registration which may lead to a missed deadline.
Payment
Payment is due at time of registration.
A copy or scan of payment needs to be submitted with registration if paying by check or purchase order. If you are having trouble meeting this requirement, please contact us to be put on a waiver list,preferably before submission.
Please note original check or purchase order will need to be received by cre8iowa within 7 days of registration. Contact if you require information on where to mail or fax payment only information.
Electronic Payments do not need a copy of invoice. The confirmation number listed in the Payment Field should be sufficient.
Participation at Tournaments
All tournament participants must follow published Iowa tournament policies found at
All tournaments are held at Ames Middles School (3915 Mortensen Road, Ames, IA 50014).
Note: participation requires an Appraiser (see Terms and Conditions for Appraiser below).
Teams participating in Challenges A-E have the opportunity to perform their solution at the Sub-state tournament. If the team is approved by the Challenge Master for their Challenge as having exhibitedvisible effort toward a viable solution at the Sub-state tournament and having met all other requirements, then the team may advance to the State tournament.
Teams participating in projectOUTREACH® will only perform at the State tournament.
Rising Stars! teams will only perform at the Sub-state tournament.
Members list
All team members must be listed.
All competitive EL, ML, SL, and C&UL teams may have up to seven (7) team members.

Note that an individual must be counted as a team member for the entire season once listed on this form. For more information, please check out p. 9 in the Rules of the Road found in your DI Program Materials.

All non-competitive-includingRising Stars!-teams have no maximum limit on team members although no more than 10 members are suggested.

Accommodation and Scheduling Request
All requests must be submitted to t least 3 weeks prior to the tournament for which you are requesting accommodations.
All requests are accommodated basedon merit and feasibility.
If any team member has special needs, please indicate the type of accommodation requested (e.g., wheel chair access).
Be specific when requesting a special scheduling consideration for both Instant and Team Challenge (e.g.: Morning performance times are needed because of a conflict with a music contest).
Appraiser
For more information please go to
Each competitive and non-competitive team participating in Challenge A-p:O must providean individual who will be trained by Students for a Creative Iowa, to represent your team as a Challenge Appraiser at the Destination Imagination® tournaments in Iowa.
This ensures that all teams have an adequate number of well-trained Appraisers to watch, enjoy, and award points for team performances at each tournament.
Appraisers makes a three-day time commitment to spend:
One full day of training on one of three different Saturdays in January or February (Appraiser’s choice of dates).
One full Saturday at the Sub-state tournament.
One full Saturday at the Iowa State tournament in Ames.
For the team to perform at the Sub-state and State tournaments,the trained Challenge Appraiser for that team must appraise at both tournaments.
A team’s trained Challenge Appraiser must have appraised at both the Sub-state and State tournaments for that team to compete at the Destination Imagination® Global Finals (if the team qualifies).
The trained Iowa Appraisers will NOT be required to appraise at Global Finals.
Child-care is NOT provided during the tournaments. Please make alternate arrangements for child care.
Training: Please allow enough time for check-in at Appraiser training at which time you will turn in completed paperwork and make your final Challenge selection. Check-in begins at 9:00 a.m. and training runs from 10:00 a.m. to 3:00 p.m. You may purchase lunch on-site for $6 or bring your own sack lunch. There will not be an opportunity to leave the site for lunch.
Conflict of interest: Please denote the Level and Challenge of the team you are representing as well as the Level and Challenge of any other team in which you are related to either a Team member or the Team Manager.
Rising Stars! Volunteer
Rising Stars!teams do not provide a volunteer to be trained as an Appraiser, but rather to serve as a Tournament Official at the Sub-state tournament.
Volunteers will serve upto a half-day shift and will be contacted by the RS Volunteer Coordinator via email to determine timing and assignments.
Assignments typically include serving as a score runner or at the Sales table.
Child-care is NOT provided during the tournament. Please make alternate arrangements for child care during shift.
Electronic signature is as legally effective and binding as conventional signature and denotes acceptance of requirements as laid out in the Iowa Membership Registration Form.