Maryland FIRST LEGO League State Championship

Team Number:(Required)

Team Name:(Required)

Registration amount is $100 per team, but additional donations are welcome.(Required)

If "other" is selected, please enter the donation amount to be charged for this registration:

Please note that your card will be charged $100 for your registration, plus the amount you enter above as a donation.

Contact Name(Required)

First Last

Contact Email(Required)

Contact Phone(Required)

Billing Address & Payment

Please enter your billing information as it appears on your credit card.

Billing Name(Required)

First Last

Billing Email(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Total

Credit Card

Please note - you may have to double click the "submit" button - you will not be double charged!