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TechJam Connected Music City Challenge Team Registration

Team Details

1. Team Details:

Team Name
Team Contact Name
Team Contact Email
Team Contact Phone

2. Please list the name and email address of each of your team members.

Space Cell	Name	Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address
	: Name	: Email Address

3. Are you happy to be added to our mailing list to be kept up to date with other relevant events and announcements? *This question is required.

4. Payment Method:
$50 per person (teams of up to four) or $200 per team.
(To be paid by 30th September 2016) *This question is required.

Cash
Electronic Transfer (An invoice will be issued to you via the email address provide above.)

5. Total Amount Paid:

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