Pre-Registration - Breakout Displays for 7Sep19 Quad Cities FIRST Tech Challenge Kickoff
Organizations or individuals wishing to have a display supporting the FIRST Tech Challenge Kickoff need to fill out this form and submit. We welcome your participation to support our local students and their learning!

Event Location: John Deere World Headquarters, One John Deere Place, Moline, Illinois

Event Date: Saturday, September 7, 2019

Display Time:
Setup 9:00 - 10:00 AM
Display 10:00 - 11:00 AM

If you have further questions, send an e-mail to

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.
Email address *
Your Full Name *
(Example John Smith)
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
A copy of your responses will be emailed to the address you provided.
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