Open all-ukrainian collegiate programming contest 2011 team registration form icon

Open all-ukrainian collegiate programming contest 2011 team registration form




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OPEN ALL-UKRAINIAN COLLEGIATE PROGRAMMING CONTEST 2011

TEAM REGISTRATION FORM

Institution Name:
Long: ___________________________________________________________________________________

Short: ___________________________________________________________________________________
Division : (I/II – offers/ does not offer advanced degree in computer science)___________________________
Oficcial Mail & E-mail Addresses: ____________________________________________________________

_________________________________________________________________________________________

Country: _________________________________________________________________________________
Team Name:______________________________________________________________________________

Coach (Faculty Advisor)
First Name:_________________ Middle Name: ____________ Last Name: __________________________
Position:_______________ Office address:______________________________________________________

EMail:_____________________________________ICQ #_________________________________________

Phone: Office:__________________ Home:_______________________ Mobile:_______________________
FAX:_________________________________________ACM #:____________________T-Shirt Size_______

Contestant 1
First Name:__________________ Middle Name: ___________________ Last Name: ___________________
Home address _____________________________________________________________________________

EMail:___________________________________________________________________________________
Home phone:___________________ Mobile:_______________________ ICQ #________________________
Expected graduation date ________ Date of a birth _______________ Participation in SEERC, total ______

Year of study:_________________ ACM#:_______________ T-Shirt Size ___________________________

Contestant 2
First Name:__________________ Middle Name: ___________________ Last Name: ___________________
Home address _____________________________________________________________________________

EMail:___________________________________________________________________________________
Home phone:___________________ Mobile:_______________________ ICQ #________________________
Expected graduation date ________ Date of a birth _______________ Participation in SEERC, total ______

Year of study:_________________ ACM#:_______________ T-Shirt Size ___________________________

Contestant 3
First Name:__________________ Middle Name: ___________________ Last Name: ___________________
Home address _____________________________________________________________________________

EMail:___________________________________________________________________________________
Home phone:___________________ Mobile:_______________________ ICQ #________________________
Expected graduation date ________ Date of a birth _______________ Participation in SEERC, total ______

Year of study:_________________ ACM#:_______________ T-Shirt Size ___________________________

Reserve
First Name:__________________ Middle Name: ___________________ Last Name: ___________________
Home address _____________________________________________________________________________

EMail:___________________________________________________________________________________
Home phone:___________________ Mobile:_______________________ ICQ #________________________
Expected graduation date ________ Date of a birth _______________ Participation in SEERC, total ______

Year of study:_________________ ACM#:_______________ T-Shirt Size ___________________________


I certify that the contestants satisfy the eligibility requirements specified in the Contest Rules.


Faculty Advisor (Coach) Signature: ___________________

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