2023 Group Testing Registration 2023 Group Testing Registration Register your student(s) to take the 2023 in-person group testing with the Iowa. Step 1 of 10 10% Parent Name(Required) First Last SCAIHS Member Number Phone(Required)Email(Required) How many students do you want to register?(Required)12345678 First Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?(Required)Core (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Second Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Third Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Fourth Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?(Required)Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Fifth Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?(Required)Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Sixth Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?(Required)Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Seventh Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?(Required)Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Eighth Student Full Legal Name(Required) First Middle Last Suffix Name student goes by(Required) Grade level(Required)3456789101112Date of birth(Required) Month Day Year Sex(Required)MaleFemaleCore or Complete?(Required)Select BelowCore (Member) $60Complete (Member) $80Core (Non-Member) $70Complete (Non-Member) $90Grade 3 must take core only. Grades 4-12 may choose core or complete. Total Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name
