IISE

Student Simulation Competition Entry Form

*Team name:                                   

* School:                                         

*Faculty advisor's name (Prefix, First Name, Last Name):

    

IIE membership number:                

*Faculty advisor's phone:              

*Faculty advisor's e-mail:               

*Faculty advisor's address:            



*
Team leader (Prefix, First Name, Last Name):                             

     

*Team leader address :                   

*Team leader phone:                   

*Team leader e-mail:                   

IIE membership number:              




*Team member's name (Prefix, First Name, Last Name):              

      

*Team member address :                   

*Phone:                                      

*E-mail:                                        

IIE membership number:             



Team member's name (Prefix, First Name, Last 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: