IDA New Team Application

Once this form is submited you will be redirected to the login page and sent a summary of your application via email. The region representative will need to review and approve this application.

Once approved you will be notified via email that your account has been activated.

Region

University Name

City

State/Prov

Country

University/Team Website

Team Email Address

Department Affiliation

Other

College Representative Information

First Name

M.I.

Last Name

Permanent Address

City

State/Prov

Country

Zip Code/Postal Code

Phone Number

Cell Number

Fax Number

Email Address

Coach Information

First Name

M.I.

Last Name

Permanent Address

City

State/Prov.

Country

Zip Code/Postal Code

Email Address

Login Information

Enter Desired Username

Enter Password

Strength indicator

Phone

This field is for validation purposes and should be left unchanged.