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 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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