Member Information
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Member Email Address (Please use a PERSONAL email address if possible; email addresses associated with a school account will not be able to access our CDA Google Classroom.) *
Member Last Name *
Member First Name *
Member Nick Name/Preferred Name
Member Date of Birth *
MM
/
DD
/
YYYY
Member Street Address (ex: 18 Phlox Dr.) *
Member Town/City (ex: Lafayette) *
Member Zip Code (ex: 70507) *
21-22 Grade Level *
21-22 Enrolled School *
Member is registering for: *
Member Shirt Size (Select One) *
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