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PROGRAMS & ACTIVITIES

MIT Museum F.A.T. Team Registration Form
Fee for a team of up to four members:
$10.00
Additional team members:
$5.00 per person (up to a maximum of 8 team members)

All teams must be registered by Friday, November 19, 2004. No team registrations can be accepted after that date.

* Chain Reaction Name:

* Select Number of Team Members:

1-4 team members, $10.00

5 team members, $15.00

6 team members, $20.00

7 team members, $25.00

8 team members, $30.00

* Team Leader Name:
(Team Leader must be 18 or older)
Team Member 2 Name:
Team Member 3 Name:
Team Member 4 Name:
Team Member 5 Name:
Team Member 6 Name:
Team Member 7 Name:
Team Member 8 Name:

 

 
Billing Information:
* Name (as it appears on credit card):
* Street1:
   Street2:
* City: * State: * Zip:
* Country:
Mailing Information (if different from Billing Information):
Name:
Street1:
Street2:
City: State: Zip:
Country:
 
 

Contact Email Address: (Required for email receipt)
Contact Phone number:

Payment Method: (MasterCard, Visa, and American Express only)