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Student Simulation Competition Entry Form

*Team name:                                    

* School:                                          

*Faculty advisor's name: 

    

IIE membership number:                

*Faculty advisor's phone:                

*Faculty advisor's e-mail:                

*Faculty advisor's address:            
 



*
Team leader:                             

     

*Team leader address :                    

*Team leader phone:                     

*Team leader e-mail:                     

IIE membership number:               


 



*Team member's name:              

      

*Team member address :                    

*Phone:                                        

*E-mail:                                         

IIE membership number:             

 



*
Team member's name:            

  


*Team member address :                   

*Phone:                                      

*E-mail:                                       

IIE membership number:           

*denotes required field


Payment Information 

Select payment type 

        

If paying by check, mail a copy of this form to:

IIE
3577 Parkway Lane, Suite 200
Norcross, GA 30092
Attention: Bonnie Cameron

Card number:                        

Expiration date: