Yes, we would like to participate on Saturday, April 24, 2010.

We are entering (check one or both)

(note: no more than six students per team may attend; only one team per level may attend from each school.)

Teacher's Name:

School:

School's mailing address

Street:

City: State: ZIP code:

Teachers's E-mail address:

Additional Contact E-mail:

School phone:

Home phone :

Note: We need your email address because we are using a paperless registration and announcement system. Your address will be automatically added to the Chemathon email discussion list, which will be used to distribute announcements and information about Chemathon.

Please also provide any additional contact points (such as another teacher or a generic school e-mailbox) in the second e-mail box above.

We are asking for phone numbers as an additional means of contacting you if needed.

Adult accompanying Level I chemistry team:

Level I coach name:

This coach is a science teacher another adult

Adult accompanying Level II chemistry team:

Level II coach name:

This coach is a science teacher another adult

Note: Each team must be accompanied by an adult. A single teacher can not accompany two teams. (i.e., two teams requires two adults.) Only 1 team may participate at each level (one each at Level I and Level II). There is a maximum of 6 students per team - no substitutions!

Comments, if any:

Please double check your information before sending.