Coach Name

School 

School Address

School City, State, Zip

School Phone   School Fax

 BILLING INFORMATION: (If different from above)

Billing Address

City, State & Zip  

COACH INFORMATION:

 Home Address

City, State & Zip

Home Phone E-Mail Address

REGISTRATION INFORMATION:

Competitive FPS Teams:@ $120 first team and $110 each additional and FREE for an incentive team

# of JUNIOR COMPETITIVE TEAMS (grades 4-6)           

 # of MIDDLE COMPETITIVE TEAMS (grades 7-9)       

# of  SENIOR COMPETITIVE TEAMS (grades 10-12)      

Community Problem Solving Teams:@ $120 first team and $110 each additional and FREE for an incentive team

# of JUNIOR CMPS TEAMS (grades 4-6)      

# of  MIDDLE CMPS TEAMS (grades 7-9)     

# of  SENIOR CMPS TEAMS (grades 10-12)   

Community Problem Solving Individual:@ $30 first individual and $25 each additional and FREE for an incentive team

# of JUNIOR INDIVIDUAL CMPS  (grades 4-6)      

# of  MIDDLE INDIVIDUAL CMPS (grades 7-9)     

# of  SENIOR INDIVIDUAL CMPS (grades 10-12)   

Non-Competitive FPS Teams Completing Two Booklets:@ $60 per team and FREE for an incentive team

# of JUNIOR Non-COMPETITIVE TEAMS (grades 4-6)                         

 # of MIDDLE Non-COMPETITIVE TEAMS (grades 7-9)                 

# of  SENIOR Non-COMPETITIVE TEAMS (grades 10-12)                   

Non-Competitive FPS Teams Completing Three Booklets:@ $80 per team and FREE for an incentive team

# of JUNIOR A Non-COMPETITIVE TEAMS (grades 4-6)                     

 # of MIDDLE Non-COMPETITIVE TEAMS (grades 7-9)                 

# of  SENIOR Non-COMPETITIVE TEAMS (grades 10-12)                   

Scenario Writing Plan A (single submission):@ $45 per scenario and FREE for an incentive writer

# of JUNIOR SCENARIO PLAN A (grades 4-6)       

# of  MIDDLE SCENARIO PLAN A (grades 7-9)      

# of  SENIOR SCENARIO PLAN A (grades 10-12)     

Scenario Writing Plan B (multiple submissions):@ $70 per scenario and FREE for an incentive writer

# of JUNIOR SCENARIO PLAN B (grades 4-6)       

# of  MIDDLE SCENARIO PLAN B (grades 7-9)      

# of  SENIOR SCENARIO PLAN B (grades 10-12)     

NEW Art Component:@ $10 per submission NEW

# of JUNIOR Art Submissions (grades 4-6)         

# of  MIDDLE Art Submissions (grades 7-9)        

# of  SENIOR Art Submissions (grades 10-12)       

Past Coaches:

Would you like a new notebook or would you like to add the revised chapters to your existing notebook?  Please let us know what you prefer.

  I do not need a new notebook.  Please send me the contents only.

  Please send me a new notebook.

 REGISTRATION FEES:

FPSPofCT will invoice you for the total amount due after receiving this registration form and PO.  Please make out checks to the Future Problem Solving Program of Connecticut, Inc., 52 Court Street, Cromwell, CT  06416. 

Submit a PO or check as soon as possible.  Payment is due by Feb. 1, 2009.

Registration materials cannot be sent out without your PO or check.