Regional Science Fair Registration Page

"*" indicates required information

Student Information

Fair ID Code: *

Region: *

First name: *

Last name: *

Address: *

City: *

State:

Zip:

Phone: *

Email: *

Sex:

Male

Female

Birthdate: (mm/dd/yyyy)

Social Security #

This must be submitted at the Fair

Grade: *

Division:*

Junior Senior

School and Teacher Information

School:*

School Address:

City:

State:

Zip:

School Phone: *

Fax:

Teacher First Name:*

Teacher Last Name:*

Teacher Email Address:*

Project Information

Project Title:*

Category:*

	Behavioral and Social Science	Biochemistry	Botany
	Chemistry	Computer Science	Earth and Space Sciences
	Engineering	Environmental Science	Gerontology
	Mathematics	Medicine and Health	Microbiology
	Physics	Zoology	Team Projects
Team Sub-category name.

Will your project display need electricity?

Yes No

Does your project need a table for display?

Yes No