Registration

> Registration
First, Last, Suffix
00-00-0000
Street Address
Street Address 2
City / State / Zip Code
(###) ### - ####
name@youremail.com

*No robotics/programming experience is necessary to be a coach. Training will be provided.

Student Group
• Grades 1-4 (ages 6-9)
• Grades 5-8 (ages 10-13)
• Grades 9-12 (ages 14-19)

Indicate Interest:
Robotics Team**
Workshops/Seminars
Summer Camp
Other

State your background and/or interest in robotics:
**Practice: minimum 1 hour per week (Fall session: Sept - December / Spring session: January- April)

Fees: Team fee is $100.00 per student (CHECKS MADE PAYABLE TO: 100 Scholars Robotics Alliance (100 SRA). Scholarships available - Contact Vivian Stepp

Click box below
Media Release: I agree to grant to 100 Scholars Robotics Alliance (100 SRA) and its authorized representatives permission to record on photography film and/or video, pictures of my participation. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, or other printed materials used to promote 100 SRA, and further that such use shall be without payment of fees, royalties, special credit or other compensation.

Registration: Submitting this form does not guarantee placement or enrollment in any of the 100 SRA programs or activities. It is, in fact, an initial step to completing a provisional registration process.

Help Provide Opportunities
& Education!
100 SRA activities have the opportunity to offer its participants the creation of robotic devices while developing skills in engineering, design, programming, fabrication, invention, and communication.