REGISTRATION

	The Robotics Art Club is a free club. It is considered an honor and a privilege to be accepted as a member. We are looking for bright, enthusiastic children that show potential in math, electronics, engineering, design or computers. If you would like to be considered for club membership by the existing club members, please fill out this form and submit it. It will be automatically sent to all the club members. The club leader will respond within two weeks. This form must only be filled out by yourself, not your parents or anyone else. Please take your time -- this is one of the ways we judge potential members.
Name	First Name	MI	Last Name
Address	Street Address Second Address (optional) City, State, Zip
Email	Email Address (The Robotic Arts Club is organized via the Internet. An email address is required to join this club.) Mother's Email Address Father's Email Address
Parents	Mother's Full Name Father's Full Name
Phone	Area Code + Local Phone Number Parent's Phone Number, if different from above.
Age	How old are you? 10 11 12 13 14 The Robotics Art Club is restricted to ages 10 through 14.
	Do you live within driving distance of Seekonk, Massachusetts? Yes No Parents are responsible for having their kids at meetings on time.
	Where did you hear about the Robotics Art Club? If other, where?
	Why do you want to be in the Robotics Art Club?
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