Pre-Registration - Display for 2016 Quad Cities FLL Kickoff
Organizations or individuals wishing to have a display supporting the FIRST LEGO League 2016 Challenge ANIMAL ALLIES need to fill out this form and submit. We welcome your participation to support our local students and their learning!

Event Location: Putnam Museum & Science Center, 1717 W. 12th Street, Davenport, Iowa

Event Date: Saturday, September 24, 2016

Display Time:
Setup 9:00 - 10:00 AM
Display 10:10 - 10:55 AM

Note: You must fill out all of the mandatory fields as indicated by a symbol * at the end of the field name (example Your Full Name *) for the form to be saved and submitted.

Your Full Name *
(Example John Smith)
Your answer
Your E-mail Address *
Your answer
Phone Number (cell phone if available) *
(format XXX-XXX-XXX - would only use if can't reach by e-mail)
Your answer
Organization you Represent or None *
Your answer
Need Table Provided (~ 6' x 3') for Your Display? *
Need 120 Volt Electricity for you Display? *
Short Description of what you will have on Display with any questions or comments *
Your answer
Submit
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