EPHS Talon Robotics (Team 2502)

General Registration Information - All Registrants

^*

Create a Login Name:

^*

Login Password:

^*

Retype Password:

^*

Individual Type - Robotics (Custom Field)

Adult Mentor

Technical Mentor

Student

Team Captain

Alumni

Parent

Prefix:

^*

First Name:

^*

Last Name:

^*

Street Address:

^*

City:

^*

State:

^*

Zip Code:

-

^*

Your Email:

Your Secondary Email:

^*

Your Phone:

Your Secondary Phone:

^*

Parent's Email (If you are a parent, repeat your email here):

^*

Parent's Cell Phone (If you are a parent, repeat your cell phone here):

Current Team Members Only - Students

Student Interests (Select all that apply)

Graduation Year

Special Dietary Needs/Allergies

Can you legally drive a car?

Yes

No

Do you own a car?

No

Yes

How many passengers can you carry?

Have you taken Research and Design?

Parent 1 First Name:

Parent 1 Last Name:

Parent 2 First Name:

Parent 2 Last Name:

Parent Secondary Email:

Parent Secondary Cell Phone:

Adults Only - Parents, Mentors, Alumni

Would you be interested in mentoring (Select all that apply)?

Please elaborate: preferred days of the week, times, areas of expertise, etc.

Are you willing to bring a meal during the build season?

Yes

No