New WCWA Account/Ensemble Request Form Use this form to request a new user and/or ensemble profile. New Account/Ensemble Registration Ensemble Name*Enter the name of the EnsembleEnsemble Type*Select the type of Ensemble(s) you would like to register Scholastic Independent School / Organization Name*Enter the School's Name. If an Independent unit, enter the organization nameAddress*Enter the primary mailing address for the School / Organization Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Director Name*Enter the name of the credentialed teacher responsible for the Ensemble/Unit/Team First Last Email*Enter the Primary Email address for the Director Enter Email Confirm Email Director Mobile/Cellular/Text*Enter the primary mobile/cellular/text number for the DirectorSecond / Additional UserUp to two users may be defined to manage the Ensemble's account in the system. Both users have the same access and privileges, so be cautious when defining a second user.Define an Additional User*YesNoDirector #2 Name*Enter the name of the Additional Director to be defined for the Ensemble First Last Director #2 Email*Enter the Email Address for Director #2 Enter Email Confirm Email Director #2 Mobile/Cellular/Text*Enter the primary mobile/cellular/text number for the Director #2TermsTermsAll Independent Ensembles must provide proof of liability insurance before they will be allowed on any event site or to compete at any event. Please provide this information no later than February 1. By registering, you acknowledge responsibility for reading and adhering to the following in order to participate in 2016 events. You further understand violation of these rules, regulations, policies or procedures could result in penalties or disqualification from an event and/or the season without refund. It is further understood and agreed that the entrant accepts full liability for any act or omission by member, staff, or guest of the entrant resulting in claims or damages at event sites, and further, that entrant will hold harmless American Drum Line Association (ADLA) / West Coast Winds Association (WCWA), its agents and employees from such claims. It is further understood and agreed that the entrant/ensemble/organization irrevocably grants permission to use their name, likeness, photographic and any reproduction of their performance at any American Drum Line Association (ADLA) / West Coast Winds Association (WCWA) event for any advertising and/or educational purpose, and releases American Drum Line Association (ADLA) / West Coast Winds Association (WCWA) from all claims, liabilities and/or damages which may arise from such use. It is also understood by the management of this ensemble or organization that it will take full responsibility for any damage, vandalism and/or misconduct at the contest site by performing members, staff, support personnel, student helpers, parents/legal guardians, and volunteers of said ensemble or organization; and it shall be the responsibility of said ensemble or organization and not of the American Drum Line Association (ADLA) or West Coast Winds Association (WCWA) for such damage, vandalism, or misconduct. By electronically signing this application you are indicating that you meet any requirements or restrictions of and are authorized by the school, school board, or managing organization to act in a supervisory capacity for the ensemble listed. Signature*I verify that all of the information on this form is correct and true, I acknowledge and accept the Terms above, and I certify that I am an authorized representative of the organization above.(Use your mouse or trackpad to draw your signature in the space above. Hold the mouse button down to enable the pen.)PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.