TCONA - Trivia Championships Of North America Participant Background 2012 Survey

Thanks for your interest in the Trivia Championshps of North America - we would appreciate having your contact information and background for our records. This information will not be shared with any third party organization.

1

Please provide your contact information

Please provide your contact information Name
Address 1
Address 2
City/Town
State/Territory/Province
Zip/Postal Code
Country
Telephone (including country and area codes)
Email address

2

Nationality

Canada

Mexico

United states

Other, please specify

3

Gender

4

Applicant Age (range)

under 20	20-29	30-39	40-49	50-59	60-69	70 or older
* Applicant Age (range) under 20	20-29	30-39	40-49	50-59	60-69	70 or older

5

City-State/Territory/Province-Country of origin (if different than current residence)

6

College, University, or other School that you most closely identify with, including City-State/Territory/Province-Country and organization web address (if available)

7

Personal Statement Of Qualification

To include previous experience in intellectual competition -- including but not limited to individual local, regional, national, or international quiz competitions; knowledge, or trivia bowl team competition; television or other media game show appearances; internet or correspondence competitions; standardized test scores; publications; education; or other notable achievements of a similar nature.

Please note placement, awards, prizes, degrees or other recognition. You may reference online sources with links as appropriate. You can submit as much or as little information as you like, or you can also send a message to tcona@comcast.net with any attachements.

Personal Statement Of Qualification

To include previous experience in intellectual competition -- including but not limited to individual local, regional, national, or international quiz competitions; knowledge, or trivia bowl team competition; television or other media game show appearances; internet or correspondence competitions; standardized test scores; publications; education; or other notable achievements of a similar nature.

Please note placement, awards, prizes, degrees or other recognition. You may reference online sources with links as appropriate. You can submit as much or as little information as you like, or you can also send a message to tcona@comcast.net with any attachements.

8

Would you be available for contact by news media covering TCONA?

Yes

No

Additional Comment