Team Name* :

Team Number* :

Schools Involved*:

Industries Involved*:

Team Website*  (NA if none)


Number of Team members interested in participating?

Would your team be interested in purchasing Robot Challenge shirts?

Yes No        If yes, how many?

  Volunteers Interested in Helping                Experienced  Inexperienced
1                            
2                            
3                            
4                            
5                            

Questions or Comments? 
(Also, Please enter the address to your team website)

Please provide the following contact information:

Name*
Organization
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Work Phone*	ex: 123-456-7890
E-mail*

Entrance Fee: $200
Checks made payable to:  TAHS Robotics Club 
Checks sent to:  
Tunkhannock Area High School                  
120 West Tioga Street                 
 Tunkhannock, PA 18657                  
Att. Mr. Scott Howell