Robotics Entry Form Entry (Robotics) "*" indicates required fields Entry InformationPlease select one:* 4-H Club FFA Chapter School Team Club/Chapter/School Name* Coach Name* First Last Coach Email* Coach Phone*Club/Chapter/School Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Team Name* Please select one:* Junior Division (3rd-8th) Senior Division (9th-12th) # of students on the team*Contest RulesI have read the Youth Robotics Challenge Official Contest RulesSignaturePaymentTeam Entry Fee* Price: Payment Type* Credit Card Pay by Mail Payments must be postmarked by 12/15/2023. Mail to: Rodeo Austin Attn: Competitive Events 9100 Decker Lake Road Austin, TX 78724Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Billing Info ZIP Code Total NameThis field is for validation purposes and should be left unchanged.