NOTE. There have been some issues reported by users of older versions of Apple's Safari web browser. If you press the "Submit Information" button and do NOT get a "Thank you" response, your information has not been successfully recorded. If this happens, you can try another browser (i.e. Firefox) or fill out the form and send an electronic copy of the document to email@example.com.
Of course, a printed version of this form is available in the Challenge guide available here.
SUBMISSIONS MUST BE SUBMITTED BY NOVEMBER 1ST.