QuizNet Registration Form

Customer Number. (This is your SCHOOL ZIP CODE):

School address:

Name: ________Date:

School:

Address:

City: ___State ___Zip

Daytime Phone ___Home Phone

E-mail address:

We can play QuizNet only on Mondays 5:30 Eastern Time.
We can play QuizNet only on Wednesdays 3:30 Eastern Time.
We can play QuizNet only on Thursdays 3:30 Eastern Time.
We are available for any of the three leagues, Monday, Wednesday, or Thursday.

Total Amount I'm sending

Method of payment:

Check Number

Purchase Order Number__