Register Online

Harmony Explosion Northwest Online Registration Form

Please fill out the following information and then submit your payment by June 25th, 2021.

Note: Required fields are marked with *

First Name: *

Nickname: * NOTE: This will be your name on your name badge! If you do not have a nickname, please enter your first name again.

Last Name: *

Date of Birth: * January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1986 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1972 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950

Gender: * Select One Male Female They/Them

Email Address: * Only one e-mail address please.

Address: *

City:: *

State/Pr - Zip/Postal Code: *

Home Phone: *

Student Cell Phone: Is texting you OK?   Yes

Parent's Name:

Second Parent's Name:

Parent's Email : * If your parents don’t have an e-mail address, just re-enter yours.

Parent's Phone: Is texting them OK?   Yes

What's your T-shirt size? Small Medium Large X-Large XX-Large XXX-Large *

Registration Fee:$40.00   U.S. funds (If you need financial assistance, Register, and then send us an email)

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