Tenth Annual (2012-2013)

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4th grade STUDENT REGISTRTAION FORM for CKRSEF

Download form as MS Word 2003 (click here) or as a PDF (click here). To fill in and email back or fax back.

Also need to print out to mail in with registration fee. (see below)

Below is the same information that can be cut and pasted into your own text program or printed out.

4th grade STUDENT REGISTRATION FORM for CKRSEF
(Central KY Regional Science & Engineering Fair)

1. Please fill in where each  *   is located below.
2. Print TWO (2) copies and have your teacher sign the paper.  In order to confirm your registration, you or your teacher should send a copy of the filled out form by email attachment (preferred), by FAX, or by the U.S. Mail.

EMAIL :               ckrsef@gmail.com

Or FAX :              Dr. Edward DeMoll, 859-323-8190

Address:
Dr. Edward DeMoll, Director for CKRSEF
Science Outreach Center
102 UK Medical Center, Annex #5
University of Kentucky
Lexington, KY 40536-0078

3. You may mail in a check for $15 made out to CKRSEF; or you may bring the $15 Friday evening when you bring in your poster and safety forms.

4. Please go to Rules www page and fill out the required forms http://web.as.uky.edu/Biology/faculty/cooper/CKYscience/rules.htm

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Personal Information
First Name  *
Last Name *
Street *
City *
State *                                                &  Zip *
Phone *                                              Email (optional) *                                                                      
*GRADE:            9th                    10th                 11th                 12th    (circle one or delete others)
School Information
Name of School *
County *
Street *
City *
State *                                                &  Zip *
NAME of Teacher *
Teacher Email *
Teacher DAY TIME Phone # *
Project Information

Title of project: *

Category (pick one- circle it or erase the others or check it off)
1. Animal Sciences
2. Behavioral and Social Sciences
3. Chemistry
4. Earth and Planetary Science
5. Engineering
6. Environmental Sciences
7. Microbiology
8. Physics and Astronomy
9. Plant Sciences

Will your project require electricity  YES or NO ? (circle answer) *
NOTICE TO ALL STUDENTS:
Your registration is not complete until the $15.00 registration fee is sent, along with the copy of the registration checked and signed by your teacher, to the Fair Director. One can bring the $15 to the fair when setting up the poster. Print two copies of this page; save one and send the other with your teacher's signature and entry.

Teacher’s Signature   *_______________________________________