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Contact:
Alexa Humes
SPARK! Co-Chair


Zachary Silva
SPARK! Co-Chair


Timothy Chow
Director, Institutional Research
Web Support


Rose-Hulman SPARK! Design Competition 2016 (April 30) Online Registration
(Sponsors: ArcelorMittal, Ford Motor Company, Halliburton, Interactive Intelligence, National Science Foundation, and Rockwell Collins)

Feel free to come alone or bring a friend. Each participant is required to register individually by completing this registration form.


STEP 1 - REGISTRANT INFORMATION:

First Name:
Last Name:
Affiliation:
  If Other, please specify:
Status:
  If Other, please specify:
Grad Class:  
Major(s):
Phone:
Email*:

Please download a copy of our Assumption of Risk and Release Waiver at http://dev.rose-hulman.edu/SPARK/waiver_2016.pdf, complete, sign and return to SPARK (scanned copy via email to humesad@rose-hulman.edu or fax to 812-877-8895) within 3 business days of your confirmed registration to complete the process.

High School Student: please provide Parent/Guardian and other information below:
Name: Relationship:
Day Phone: Cell Phone:
Email:
Certification: I certify that the information given on this registration is complete and accurate and that I have completed this registration with full knowledge and consent of my parent(s) or legal guardian(s).
 
Your Age (as of April 30, 2016):


*Please ensure your email address is accurate and valid. An email confirmation will be sent to the email address above. Please be sure to look for the message from "SPARK! Design Competition" in case it is blocked by the spam filter in your email. Proper ID is required for verification during check-in.


STEP 2 - REGISTRANT PREFERENCES:


Do you prefer vegetarian meal?

Yes         No
Do you have any special needs to accommodate?
(e.g., allergies, special diet, etc.)

Yes         No
  If Yes, please specify:

What is your T-Shirt size (preference)?

S  M  XL XXL

How did you hear about SPARK?


Would you like to be contacted by Rose-Hulman for future events?

Yes         No


T-shirts will be pre-ordered and every attempt will be made to provide you one according to the size indicated on this form. This event will be held in the Field House of the Sports and Recreation Center (SRC) on the campus of Rose-Hulman Institute of Technology.

Questions: please contact Alexa Humes via email at  humesad@rose-hulman.edu.