Application For Enrollment

Child’s Name:________________________

Adult’s Name:________________________

Home Address:_______________________
                      City:__________
                       ZIP:______

Home Phone:______________

E-mail Address:__________________

T-Shirt Size:__

Please Check Program:
                 
                                          __Lego League $75.00
                                          __Regular Session $350.00
                                          __Advanced Session $365.00
                                          __Girls Only $365.00

Workshop Date:_______

*Please make checks payable to:
     EAST LAKE HIGH SCHOOL ROBOTICS BOOSTERS INC.

*Mail To:        J. Paul Wahnish
                           36181 East Lake Road #287
                           Palm Harbor, FL 34685