Team Name:

Placerita Robotics

Team Fee Paid:

Qualify for

LAST NAME

FIRST NAME

Method of Indivdual Registration

Minor Under 18yrs

Wrist band

Event T-shirt ($100)

Shirt Size

Free Lunch ($100)

Free Dinner ($100)

CHECKS/CASH

ON-LINE

GRAND TOTAL

Eisen

Adam

Member

Online

Yes

No

L

No

No

$                     -

$                     -

Hauss

Sam

Member

Online

Yes

No

M

No

No

$                     -

$                     -

Hung

Emily

Member

Online

Yes

No

S

No

No

$                     -

$                     -

Kass

Paul

Captain

Online

Yes

Yes

5/22/2010

L

Yes

Yes

$    100.00

$            100.00

$            100.00

$            200.00

Rompal

Katie

Member

Online

Yes

No

M

No

No

$                     -

$                     -

Rosso

Ryan

Member

Online

Yes

No

M

No

No

$                     -

$                     -

Rosso

Steven

Member

Online

Yes

No

L

No

No

$                     -

$                     -

Solomon

Spencer

Member

Online

Yes

No

M

No

No

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

GENERAL DONATIONS

$                     -

$                     -

Registration Overpay

$                     -

$                     -

Corporate Sponsor

$                     -

$                     -

Day Of - Team Raffles

$    166.00

$      91.00

$      41.92

$            298.92

$            298.92

Day Of -Booth Sales

$                     -

$                     -

8

1

1

1

$    100.00

$    166.00

$      91.00

$      41.92

$             -

Count of team members

8

Total # of bands

Total # of shirts

Total # of lunch

Total # of dinner

extra gift from reg

relay

relay

acs office

5/26/2010

$            398.92

$            100.00

$            498.92

Entry # 1

Entry # 2

Entry # 3

Entry # 4

(Checks/Cash)

(On-Line Only)

Total to Date

Placerita Robotics