Sign Up HACK@CODE (Private)

Registration

December 2020

*Please submit another form if you are registering more than 3 teams.

Adult / Teacher / Coach *

Name *

First

Last

Your Email *

Phone

Address *

Address Line 1

City

State / Province / Region

Number of Teams *

Team 1: Name *

Team 1: Member 1 *

Date of Birth (Member 1) *

School *

Team 1: Member 2

Date of Birth (Member 2)

School (copy)

Team 1: Member 3

Date of Birth (Member 3)

School (copy) (copy)

Any member done coding before?

How did you learn about HACK@CODE? *

Credit Card *

Card Number

Security Code

Name on Card

Expiration/

Message