2010-2011 Pittsburgh Regional Future City Competition
School Registration Form

School Registration Fee for Future City Competition: $25
Please make check payable to National Engineers Week Programs and mail to:
Carnegie Science Center
Attn: Carol Schoemer
One Allegheny Avenue
Pittsburgh, PA 15212-5850

Date:

Teacher's Name:
Grade Level: 6th Grade   7th Grade   8th Grade
Number of students participating: Number of Teams:
Principal's Name:
School Name:
School Address:
City: State: Zip Code:
School Telephone: Fax:
School E-mail:
Home E-mail:
Teacher's
Home Address:
City: State: Zip Code:
Home Telephone:

One copy of SimCity software will be provided upon receipt of registration. Platform requested:
Macintosh PC

Do you have an engineer mentor?
Yes No

If you already have an engineer-mentor, provide mentor information below:

Engineer's Name:
Company Name:
Work Address:
City: State: Zip Code:
Work Telephone: Fax:
Work E-mail:
Home E-mail:
Home Address:
City: State: Zip Code:
Home Telephone:
Technical Society Affiliation

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