REGISTRATION DUE IMMEDIATELY AFTER YOUR DISTRICT COMPETITION
Registration Fee is $120 per team
($95 if you provide a working laptop for scorekeeping)

Registration deadline is April 10, 2012.
A $20 late fee will be assessed to any teams not registered by that date.

Please submit a separate form for each team. Once you have submitted your registration, please send the registration fee to the address at the bottom of the form.

If you have any questions, please send them to us by clicking the following button:

or contact Todd Papendick at:
Cell: (630) 653-1132
Email: j.b.q "AT" sbcglobal.net

2012 Great Lakes Region JBQ Tournament Registration

Please fill in the following information and select the "Submit" button at the bottom of the form.
Do not press the "Enter" key while filling out the form. Doing so will submit the form.

CHURCH INFORMATION
Church Name:
Church City:
Church State:

CONTACT INFORMATION
Contact Name:
Contact Email:
Contact Phone:

TEAM INFORMATION
Coach Name:
Cell Phone of someone traveling with the team:
Team Place at Districts:

LAPTOP INFORMATION We need 12-14 laptops for keeping score electronically in each room. Please indicate below the number of laptop computers that you can provide. (The laptops need to be running Windows XP, Vista or 7.)
Number of Laptops you can provide:

QUIZZER INFORMATION
	Name	Grade	Age
Quizzer 1:
Quizzer 2:
Quizzer 3:
Quizzer 4:
Quizzer 5:
Quizzer 6:
Quizzer 7:
Quizzer 8:

OFFICIALS INFORMATION
Each church is required to bring at least two officials per team registered. Each church is encouraged to provide at least 1 QuizMaster or ScoreKeeper for every team registered. If you are able to bring more, please list their information in the extra spaces below.
Name	Positions (check all that apply)	Experience	Age	Email
	QM SK TK
	QM SK TK
	QM SK TK
	QM SK TK

ADDITIONAL COMMENTS

Antispam code - Please enter the 3 black characters in the image (below, left) in the text box (below, right) before selecting "Submit". If you do not, you may lose all of the information you entered!

Each church must bring at least one quiz set (with 8 working paddles and an extension cord)
for every team registered.

Please remember to send your check (payable to "Illinois Student Ministries" (Great Lakes JBQ in the memo)) to:

Illinois Student Ministries
attn: Great Lakes JBQ
17280 Lakeside Drive
Carlinville, IL 62626

(If not sending a church check, please write your church name on the check or include it on a note.)

By submitting this registration form, you consent to having any and all pictures taken during the tournament to be posted on this website. You also consent to having any and all names and results of the participants posted on this website.

After submitting this registration form, you will be directed to another web page that acknowledges that your registration has been successfully submitted. If you do not see this page, please check your registration form for any errors.

[Press the above button to submit your registration form.]

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Junior Bible Quiz graphics, logos, product images, and service names are trademarked by the General Council of the Assemblies of God.
Use of these images and trademarks without written authorization is forbidden and is a violation of federal and international laws.