Today's Date:

-- mm/dd/yy

Team Sponsor Name:

e.g. Micron Foundation

Your team's name:

e.g. "The A-Team"

Your team's category:

High School or Junior High Student Team ($500)
Professional Organization/University Groups ($500)
Corporate Team - Less than 50 employees ($1,000)
Corporate Team - 50 or more employees ($1,500)

Team Captain Contact Information:

First Name
Last Name
Organization or School
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Phone
FAX
E-mail

Team Member 2 Contact Information:

First Name
Last Name
Organization
E-mail

Team Member Three contact Information:

First Name
Last Name
Organization
E-mail

Payment Type:

Check (Payable to: University of Idaho Parents as Teachers, 714 W State, Suite 100, Boise, ID 83702)
Purchase Order
Our Sponsor will contact UI PAT

If we win, we will donate our prize to:

Educational or youth program's Name: