Pott Foundation Tri-State Science and Engineering Fair

Registration Page

"*" indicates required information

Student Information - team leader or designated team member

Fair ID Code: *

Region: *

First name: *

Last name: *

Address: *

City: *

State:

Zip:

Phone: *

Email: *

Sex:

Male

Female

Birthdate: (mm/dd/yyyy)

Social Security #

(req'd for State Fair)

Grade: *

Division:*

Junior (grades 6-8) Senior (grades 9-12)

List of team members

First name: *

Last name: *

First name: *

Last name: *

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:*

Click Here for category descriptions

Behavioral and Social Science	Biochemistry	Botany
Chemistry	Computer Science	Earth Sciences
Engineering	Environmental Science	Mathematics
Medicine and Health	Microbiology	Physics
Space Sciences	Zoology

Abstract

Please type abstract in the box below.

Project Display Needs

Will your project display need electricity?

Yes No

Does your project need a table for display?

Yes No

T-Shirt Size (all adult sizes)?

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THANK YOU FOR PARTICIPATING IN THE POTT FOUNDATION TRI-STATE SCIENCE AND ENGINEERING FAIR
March 12-13 at the University of Southern Indiana