Team 3176 Application 2019-20
Application for membership on Team 3176
Team 3176 Application
This information is for FIRST as well as Team 3176
First Name *
Your answer
Last Name *
Your answer
Preferred Name
Your answer
Gender *
Phone Number *
(XXX)-XXX-XXXX or N/A
Your answer
Student Birth Date *
MM
/
DD
/
YYYY
Grade Level *
Student Email *
One that you check regularly. This is the main way the team will communicate with you. If you already did the early application, you can ignore.
Your answer
Student ID Number *
Your answer
Student Address (Street, City, State, ZIP) *
Your answer
How Many Team Jerseys Do You Own? *
Student Jersey / T-Shirt Size *
Have you or are you taking a PLTW course? *
Diet Preferences / Restrictions *
The team will try but may not guarantee full compliance with diet preference
Safety Glasses *
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