On-Line Registration

Please provide the following information. * indicates a required field.
DO NOT SEND YOUR SOCIAL SECURITY NUMBER THROUGH THIS FORM!!!

Project and School Information

Project Title:*
School:* Project Advisor:
Is Electricity Needed?* Yes No
Category:*

Senior Division (Grades 9-12 only)	Junior Division (Grades 6-8 only)	Intermediate Division (Grades 4-5 only)
Behavioral/Social Sciences Biochemistry Botany Chemistry Computer Science Earth and Space Science Engineering Environmental Science Gerontology Mathematics Medicine and Health Microbiology Physics Zoology Team/Group Project	Behavioral/Social Sciences	Behavioral/Social Sciences

	Physical Science	Physical Science

	Biological Science - Animal	Biological Science - Animal

	Biological Science - Plant	Biological Science - Plant

	Applied Science	Applied Science

	Team/Group Project	Team/Group Project

Student 1

First Name:* Middle Initial: Last Name:*
Mailing Address: Home Telephone: (Area Code)
City: State: Zip Code: Grade:*
E-Mail Address:*

Student 2 (Group/Team Projects Only need to complete information for Students 2 and 3)

First Name: Middle Initial: Last Name:
Mailing Address: Home Telephone: (Area Code)
City: State: Zip Code:
E-Mail Address:

Student 3 (Group/Team Projects Only need to complete information for Students 2 and 3)

First Name: Middle Initial: Last Name:
Mailing Address: Home Telephone: (Area Code)
City: State: Zip Code:
E-Mail Address:

Enter any Comments or Special Information in the space provided below: