WASHINGTON STATE REGIONAL COMPETITION SCHEDULE

							             2012 NATIONAL ENGINEERS WEEK FUTURE CITY COMPETITION™

                                     Washington State Regional Competition
                                              Registration Form
Each registered school may bring up to five teams to compete in the Regional Competition on Saturday, January
21, 2012. Only one team from each school may advance from the morning preliminary competition to the afternoon
final competition. The same teacher and/or mentor may be a member of each of the five teams that participate in
the morning preliminary competition from any one school.

                School/City/State:


       TEAM 1
       Future City Name:
       Teacher Name:
       Engineer Mentor Name:
       Student Team Members
                                     Name:                                    Grade:
                                     Name:                                    Grade:
                                     Name:                                    Grade:


       TEAM 2
       Future City Name:
       Teacher Name:
       Engineer Mentor Name:
       Student Team Members
                                     Name:                                    Grade:
                                     Name:                                    Grade:
                                     Name:                                    Grade:


       TEAM 3
       Future City Name:
       Teacher Name:
       Engineer Mentor Name:
       Student Team Members
                                     Name:                                    Grade:
                                     Name:                                    Grade:
                                     Name:                                    Grade:


       TEAM 4
       Future City Name:
       Teacher Name:
       Engineer Mentor Name:
       Student Team Members
                                     Name:                                    Grade:
                                     Name:                                    Grade:
                                     Name:                                    Grade:

       TEAM 5
       Future City Name:
       Teacher Name:
       Engineer Mentor Name:
       Student Team Members
                                     Name:                                    Grade:
                                     Name:                                    Grade:
                                     Name:                                    Grade:


Forms must be received by Karen Pavletich (Washington State Future City Regional Coordinator) by Friday,
January 13, 2012. Forms may be returned by e-mail to: karen.pavletich@washingtonfuturecity.org