Player's First Name
*
Player's Last Name
*
Player's Gender
*
Please Select
Male
Female
Player's Age
*
Please Select
14
15
16
17
18
19
20
Note - Participating players must be between 14 and 20 years old
Email
*
example@gmail.com
Input your Order Number or Invoice Number from your rebel purchase here.
*
Note use your Order Number for online purchases. Use your Invoice number on your receipt for in-store purchases
Upload a picture of your Receipt from your rebel purchase here.
*
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