School Name:________________________________________
School Address:_____________________________________
____________________________________________________
Contact/Coach Name:_________________________________
Contact phone number:_______________________________
Contact email address:______________________________

ABOUT YOUR CLUB (circle all that apply)

Does your school currently have a robotics program? Yes No
Have you competed in: F.R.T.K.I. Lego league Panasonic challenge
How many students in your program: 0-5 6-10 10-20 > 20
Grade levels: Middle school HS
Do you currently have access to robotics kits: YES NO
What kind: _____________________________________________________
Does your school currently have a budget for robotics: YES NO
Are you willing to participate in Robo-Maddness 2007: YES NO
Do you have access to computers with USB ports: YES NO
Does anyone in the club have knowledge of programming in basic: YES NO
Does anyone in the club have knowledge of simple circuits: YES NO
Please return by FAX or mail to:
ATTN: David Peins
Robodyssey Systems LLC
20 Quimby Ave
Trenton NJ 08610
Phone 609-585-8535
Fax 609-585-8535