Southwestern New Mexico Regional Science And Engineering Fair 2016 Registration Form

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Southwestern New Mexico Regional Science and
Engineering Fair 2016 Registration Form.
Student Name:_____________________________________________________ Grade: _________
Student Date of Birth:____/_____/________
Student Gender:
M
F
Project Title: ________________________________________________________________________
Student Address: ___________________________________________________________________
___________________________________________________________________
Student Phone: _______________________Student e-mail: _______________________________
Is this a team project?
Yes
No
Are you the leader?
Yes
No
If Yes:
Team Member Name:_______________________
Birth Date:___/___/___
Gender
M
F
Team Member Name:_______________________
Birth Date:___/___/___
Gender
M
F
Sponsor/Parent Name: ______________________________________________________________
Sponsor/Parent Cell: _____________________ Sponsor/Parent Phone: ___________________
Sponsor/Parent E-mail: _________________________________
School: _____________________________________________________________________________
PLEASE CIRCLE YOUR PROJECT’S CATEGORY:
Behavioral and Social
Botany: Plant Sciences
Cellular and Molecular
Sciences
Biology
Chemistry
Computer Sciences
Earth & Planetary Science
Energy & Transport
Engineering
Environmental Sciences
Mathematical Sciences
Medicine & Health
Microbiology
Physics & Astronomy
Zoology: Animal Sciences
Will you need an electrical outlet at your display?
_____Yes
_____No
PLEASE CHECK INCLUDED PAPERWORK:
REQUIRED FOR ALL PROJECTS:
This Form (Registration Form)
Liability and Publicity Release
Form 1 (Checklist for Adult Sponsor)
Form 1A (one for each student)
Form 1B (Approval Form)
Student Research Plan
ADDITIONAL FORMS: (please see rules to determine if you need one or more of these
forms).
Form 1C (Regulated Research Inst.)
Form 2 (Qualified Scientist)
Form 3 (Risk Assessment)
Form 4 (Human Subjects)
Form 5 A or B (Vertebrate Animals)
Form 6 A or B (Biological Agents of Animal Tissues)
Form 7 (Continuation Project)
Will you require special assistance? If yes, please explain: ____________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

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