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Registration Form

School / Team Name*
Name of Advisor / Teacher*
School/Team Address*
City*
State
Country*
Zip/Postal Code*
Email Address*
Day Phone (Country code / area code / phone no.)*
Evening Phone
Mobile Number
Fax No.
School/Team Website
Payment:
Team Registration	Rs.6,000 [Indian teams pay by Demand Draft] US$150 [International Teams pay by Credit Card]
If paying by Demand Draft (DD), please enter following details:
DD No.
Name of Bank and City
DD Date
Please enter the security code*

I understand that if our Team qualifies for the International Space Settlement Design Finalist Competition at Johnson Space Center in Houston during July 2012, we will be required to fund our own travel to and from Houston.

I understand that if our Team qualifies for the Asian Region Space Settlement Design Semi- Finalist Competition in India, we will be required to fund our own travel to and from "Om-Shanti Retreat Center, Gurgaon" and share the cost of boarding and lodging with the organisors.

* mandatory fields

Important: Teams from Pakistan, please use demand draft service (incase you cannot pay by credit card). The amount would be USD 150.

If you have chosen the Demand Draft option for payment, please send the signed document with Demand Draft drawn in favour of 'Atlantis Research' payable at New Delhi, India to the following address:

Abhishek Agarwal
c/o Atlantis Research
712, Ring Road Mall, Sector 3
Rohini, New Delhi 110085, India
Phone: +91 97170 01231