4th Indian National Space Settlement Design Competition

Team Data Form

Name of the primary teacher/advisor: ________________________________________

School (or other Group Name): ________________________________________

School Address: ________________________________________

School City, State, Zip or Postal Code: ________________________________________

Country: ________________________________________

Daytime Telephone at School: ________________________________________

Cellular or Mobile Phone: ________________________________________

Fax: ________________________________________

E-mail address: ________________________________________

Names, [gender], and (grade/age) of 12 students currently expecting to attend the Finalist Competition: (we
advise that participants be at least 14 years old, and not older than 19)
Name [gender](grade/age)

F
_______________________________[___](___/___) F
_______________________________[___](___/___)
F
_______________________________[___](___/___) F
_______________________________[___](___/___)
F
_______________________________[___](___/___) F
_______________________________[___](___/___)
F
_______________________________[___](___/___) F
_______________________________[___](___/___)
F
_______________________________[___](___/___) F
_______________________________[___](___/___)
F
_______________________________[___](___/___) F
_______________________________[___](___/___)

Names of two adult advisors currently expecting to attend the Finalist Competition:

F
__________________________________________[___] F
______________________________________[___]
I understand that if our Team qualifies for the Indian National Space Settlement Design Finalist
Competition October 2020, we will be expected to finance our own travel to / from Om Shanti Retreat
Center, Manesar and share the cost of boarding / lodging during the competition.

________________________________ _________________________________
Signature of primary chaperone/advisor Date