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Notes:

• This form must be used to register an entry.
• The registration deadline is midnight on September 21, 2005.
• Please submit a separate form for each team you wish to register. Identify the different teams as #1 and #2.
• The team sponsor must be registered for the CCSC:Southeastern Conference. (Students may also register at a reduced rate, but it is not required unless they are the representative of a winning team.)
• Your registration will be complete upon receipt of this form by Becky Tallon, Web Contest Director. and receipt of the registration fee by Dr. Dee Medley, CCSC:SE Treasurer. The fee is $20 per entry.
• Before submitting this form, please be sure to read all additional contest information thoroughly.
• Your electronic registration will be confirmed by return e-mail. If you do not receive this confirmation within 24 hours, please contact Becky Tallon to make sure that you are registered.

School Name:

Developer #1:
Developer #2:
Developer #3:

A faculty member must sponsor each developer.

Faculty Sponsor:
Work Address:
City, State, Zip:
Telephone:
E-mail:

I certify that the above named student is currently enrolled at this school, and are thereby eligible to participate.

Name:
Date: