House Captain Registration Form

House Captain (Primary Contact Information)

Please note that all fields denoted with a star (*), are required.
Last Name:*		First Name:*		M.I.
Address:*		City:*		State:*
Zip Code:*		Home Phone:
Cell Phone (if available):		Work Phone:*
Email:*		Fax:
Group/Team Name:*
If your team does not appear – email info@christmasinoctober.org your full team name and he will add it to the list.
Check the categories that describes you best:
Group Leader (Manage multiple teams):
House Captain (Lead one team):

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