Texas BeyBlade League 

Supported By UTD Chapter of The National Society of Black Engineers

PLEASE COPY AND PRINT THIS

FORM TO BRING FOR THE EVENT


BEYBLADE INSTITUTE OF SPIN TECHNOLOGY & UTD TEXAS BEYBLADE LEAUGE

Learning Science and Math Through Fun and Play.”


Student Registration   --   Student Information

PLEASE PRINT




  1. First Name: _____________________________________         Last Name:    _________________________________________________

  2. Home Mailing Address      ___________________________________________________

  3. (house number, street,)     ___________________________________________________

  4. city, state, zip code):           ___________________________________________________

  1. Primary Email Address: (updates & notices to be sent)   _______________________________________________________________________

  1. Primary Phone Number / with area code: (circle) CELL HOME   _________________________________________________________________

  1. Secondary Phone Number / with area code: (circle) CELL HOME   _______________________________________________________________


  1. School:    _______________________________________________________________             Grade: ________________


For Minors (under 16): Parent / Guardian Information

  1. NAME:  ____________________________________________________________________________

  2. Primary Email Address: (updates & notices to be sent)    ______________________________________________________________________

  1. Primary Phone Number / with area code: (circle) CELL HOME   _________________________________________________________________

  1. Secondary Phone Number / with area code: (circle) CELL HOME   _______________________________________________________________


Optional Information (for statistical purposes)

  1. Ethnicity: _______________________________________________________

  2. Date of Birth: (mm/dd/yyyy) _______ / _________ / ____________      Age: _____        Gender: (circle) MALE FEMALE