Team Registration Form For The FLL Tournament Series In Illinois

Team Name:
Team Number: (from national registration)
Password: (make one up, but remember it!)
Verify Password:
# of Students on Team:

Name of the Person Registering the Team:
Email Address of the Person Registering the Team:
Phone # of the Person Registering the Team:

Coach:

Name:
Address:
City:
State:
ZIP Code:
Phone:
E-mail:
INSciTE Illinois has my permission to give out this email address to coaches or others seeking information about teams in my area.
INSciTE Illinois has my permission to give out this phone number to coaches or others seeking information about teams in my area.
Secondary Contact: (highly recommended)

Name:
Address:
City:
State:
ZIP Code:
Phone:
E-mail:
INSciTE Illinois has my permission to give out this email address to coaches or others seeking information about teams in my area.
INSciTE Illinois has my permission to give out this phone number to coaches or others seeking information about teams in my area.

As coach of this team, I agree that I will give properly completed and signed consent forms (or copies of the properly completed forms) for all team members and coaches to the sign in desk(s) at each tournament my team attends, including the State Tournament.

Because I am not the coach of this team, I agree to see that the actual coach of this team fulfills the above requirement.
I am coaching more than one team.

If coaching more than one team, please fill out the following questions:
I require all of the teams I am coaching to attend the same regional tournament.

If multiple teams must attend the same tournament, please list their team numbers and names in this box:


Regional Tournaments:
LocationDate
BataviaDec 17th, 2011 (Saturday)
Champaign/UrbanaDec 3rd, 2011 (Saturday)
Chicago (Girl Scout Friendship Center)Dec 17th, 2011 (Saturday)
Chicago (Miles Davis Magnet Academy)Dec 10th, 2011 (Saturday)
Chicago (UIC)Dec 10th, 2011 (Saturday)
HarvardDec 3rd, 2011 (Saturday)
Lake ZurichDec 10th, 2011 (Saturday)
Mount ProspectDec 17th, 2011 (Saturday)
PalatineDec 18th, 2011 (Sunday)
PeoriaDec 10th, 2011 (Saturday)
RockfordDec 10th, 2011 (Saturday)
StreatorDec 3rd, 2011 (Saturday)
ZionDec 10th, 2011 (Saturday)


Regional Tournament Preferences: Please pick your three most favored tournament locations/times. Every effort will be made to give your team one of your top choices of regional tournament location. You may change this preference later. (If you change your preference, please also send an email with your team number to contactfllillinois@gmail.com indicating that you have updated your tournament preference.
Choice 1
Choice 2
Choice 3


Grants: INSciTE Illinois applies for grants to fund our activities. Many funding sources require the following information about team members (please fill in the number of participants where applicable)
Boys:
Girls:

African American:
Asian American:
Caucasian:
Hispanic/Latino:
Native American:
Other:

 County:

Potential Publicity: List the schools currently attended by the team members
School City Local Newspaper
 Additional lines will appear as needed.

Potential Funding: There are many companies that sponsor community activities such as FLL. In order to show the participation of their employees or employee family members in this program, we ask that, if possible, you identify the companies that employ team members parents and/or coaches.
Company # of Team Members # of Coaches/Volunteers
 Additional lines will appear as needed.
Volunteers: We'd appreciate it if you would be willing to help out the INSciTE Illinois state organization. Please check off anything below that you might be interested in volunteering for.









Important Information:
When you press "submit", you will be able to print out a copy of your registration information. Please remember your team number and password so you can update your information as team members or other details about your team change. Plan to update your information at least once during the season to ensure that we have the correct information and to see that we are able to contact you if necessary.

NOTE: Your registration is not complete until your $65 registration fee is received by INSciTE Illinois. You may pay on-line through PayPal (using a PayPal account or a credit card) or you can send a check to INSciTE Illinois (see next page).

If any team member or coach has a disability that we can help accommodate, please email us at contactfllillinois@gmail.com. We will do our best to assist you.


If you have any problems when registering, please contact contactfllillinois@gmail.com.