Name: Phone Number:

e-mail: School (No Abbreviations):

Competition/Project Name:

Project Deadline or Date of Competition:

Date Samples Are Needed By:

Shipping Address: City:

State: Zip code/Postal code:

Advisor/Professor/Mentor Name:

Advisor/Professor/Mentor e-mail:

Advisor/Professor/Mentor Mailing Address:

City/State:

Zip code/Postal code:

Number of students/individuals on team or project:

Tell us about your project/design:

How will igus products be used in your design?

How did you hear about igus and the Y.E.S. Program?
Internet Search
Robotics/Competition website (Please Specify)
Professor
Other (Please Specify)

How is your project funded? Do you have a budget or must you fund raise/secure parts on your own?

Do you need catalogs? Yes No
If yes, which catalogs would you like to receive?:
E-Chain/Cables Bearings/Linear guides
Catalogs on CD

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

Do you need decals? 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: