Student Robotic Competition
10th International Conference on Robotics
& Remote Systems for Hazardous Environments

To enter the design competition, please return $25 (US Dollars) and this form to:

Christopher Niezrecki
Department of Mechanical and Aerospace Engineering
University of Florida, 231 Aerospace Building
P.O. Box 116250
Gainesville, Florida 32611-6250

Make checks payable to: Christopher Niezrecki

All entries must be received by February 13, 2004.  Any entries arriving after this date will not be considered.

Faculty Member Sponsor: ___________________________________________________

School Name: ____________________________________________________________

Address: ________________________________________________________________

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Phone: ____________________________  Fax: _______________________________

e-mail: _________________________________________________________________

Team Captain Name: _________________________ e-mail: ____________________

Team Member Names: _________________________ e-mail: ____________________

     _________________________ e-mail: ____________________

     _________________________ e-mail: ____________________

     _________________________ e-mail: ____________________

Team Name: ______________________________________________________________
 

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To be completed by ANS 10th Topical:

Fee Paid: _______________________  Fee Received By: _____________________

Date Paid: ______________________  Team #: ______________________________
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