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Y.E.S. Program Sample Request Form for FIRST Teams

Name: Phone Number:

e-mail: School:

FIRST Robot Deadline:

Date Samples Are Needed By:

Shipping Address: City:

State: Zip code/Postal code:

Advisor/Mentor Name:

Advisor/Professor/Mentor e-mail:

Advisor/Professor/Mentor Mailing Address:

City/State:

Zip code/Postal code:

Number of students on FIRST team:

Tell us about your FIRST robot/design:

How will igus products be used in your FIRST robot?

Do you need catalogs? Yes No
If yes, do you need: E-Chain/Cables bearings/linear guides Both

Would you like to request more of the products included in the 2006 kit of parts? If so, please indicate the quantity of each product required below. If you do not need one of the products, please leave the box blank.

DryLin N linear guide system
Part Number: NK02-27-2-457

DryLin R solid plastic bearing
Part Number: RJI-01-10

DryLin S aluminum shafting (18 inches)
Part Number: AWI-06 (listed as AWI-05 in data guide)

DryLin S aluminum shafting (18 inches)
Part Number: AWI-10

Iglide J bearing
Part Number: JSI-1012-12

Iglide J bearing
Part Number: JFI-1012-12

Igubal rod end
Part Number: EBRI-06R

Igubal rod end
Part Number: EBRI-10R

Igubal flange bearing
Part Number: EFOI-06

Igubal pillow block
Part Number: KSTI-10

Igubal clevis joint
Part Number: GERIK-06

E-Z Chain (1 m)
Part Number: Z06-16-018-0

What additional products/parts do you need? Be sure to list quantity and/or length of each.
List part numbers if you know them:

Does your team need additional decals for its robot? Indicate the quantity here:
Y.E.S. logo decal

 igus small block decal

igus large block decal

If you don't already know what products you need, please list all relevant technical information and questions here:

Other questions or comments:


For more information on the Y.E.S. Program, please contact Courtney Toomey, Y.E.S. Program Administrator at (800) 521-2747 ext. 146 or via e-mail at ctoomey@igus.com.

IGUS SAYS Y.E.S. TO FIRST!

If you are a student or team involved in the FIRST Robotics Competition and would like free samples, please fill out the request form below. You can request additional igus products included in the 2006 FIRST kit of parts or other products from the igus catalog. Make sure to indicate quantities and part numbers when filling out the form. Someone from igus will contact you shortly to confirm your request has been received.