LOUISIANA REGION III SCIENCE AND ENGINEERING FAIR ENTRY FORM

Must be returned by March 12, 2004 to:

LOUISIANA REGION III SCIENCE AND ENGINEERING FAIR, DIRECTOR, Department of Geosciences, The University of Louisiana at Monroe, Monroe, Louisiana  71209-0550

All blanks must be filled in.  All information is applicable.  Incomplete forms will be returned.  Also, include copies of abstract, research plan, and each required certification form.  DO NOT SEND ORIGINALS!  All information presented on this entry form and on all other forms submitted with this form is final.  This form may be duplicated.  It is suggested that each contestant bring a bag lunch.

A $15.00 non-refundable entry fee must accompany each application ($30.00 for Team Projects).  Please do not send cash.  Make checks payable to:
LOUISIANA REGION III SCIENCE AND ENGINEERING FAIR.

PLEASE PRINT OR TYPE NEATLY

Exhibitor's Name:
Mr.  Ms.		______________________________________________			___________________________
(Circle)			Last 					First					MI				Social Security No.

Address:	__________________________________________________			Grade:	______________

___________________________________________________		___________________________
City						State				Zip Code					School District

___________________________________________________		(______) ___________________
						School Name										School Phone Number

____________________________________________________________________________________
TITLE OF EXHIBIT (Max. of 60 characters including spaces and punctuation)

EXHIBIT SIZE:		Width:	__________ inches		Depth:	__________ inches		Height:	__________ inches
(Please be exact)				(Max. is 48")					(Max. is 30")				(Max. is 108" including 																						table of height=36")
EXHIBIT REQUIRES ELECTRICITY?	The Exhibitor must bring a 25 foot extension cord to the fair!

Please mark the one best classification for your entry:

SENIOR DIVISION (Grades 9-12)									JUNIOR DIVISION (Grades 6-8)

S 1	(	)	Behavioral & Social Sciences						J 1	(	)	Behavioral & Social Sciences
S 2	(	)	Biochemistry										J 2	(	)	Biochemistry
S 3	(	)	Botany											J 3	(	)	Botany
S 4	(	)	Chemistry										J 4	(	)	Chemistry
S 5	(	)	Computers										J 5	(	)	Computers
S 6	(	)	Earth & Space Sciences							J 6	(	)	Earth & Space Sciences
S 7	(	)	Engineering										J 7	(	)	Engineering
S 8	(	)	Environmental Sciences							J 8	(	)	Environmental Sciences
S 9	(	)	Mathematics										J 9	(	)	Mathematics
S 10(	)	Medicine and Health								J 10	(	)	Medicine and Health
S 11(	)	Microbiology									J 11	(	)	Microbiology
S 12(	)	Physics											J 12	(	)	Physics
S 13(	)	Zoology											J 13	(	)	Zoology
S 14(	)	Team Projects*									J 14	(	)	Team Projects*

										Exhibitor's Signature:  	______________________________________

_____________________________________						______________________________________
(Printed Name of Exhibitor's Science Teacher)						(Signature of Exhibitor's Science Teacher)

*Team Projects must complete an entry form for each exhibitor.