------------------------------------------------------------------------ LAHSPC 2002/2003 REGISTRATION FORM ------------------------------------------------------------------------ Please fill out this form with black or blue ink and submit it with your first set of solutions to the following address: LAHSPC, Department of Physics, MSU, East Lansing, MI 48824. ------------------------------------------------------------------------ Your name, signature, grade, PIN, the school's name are required in order to participate. You should name one or two teachers in physics, science or mathematics guiding you in this competition. Your address and email is used only to reach you if it is necessary. Otherwise this information is handled confidentially. ------------------------------------------------------------------------ STUDENT'S : NAME ----------------- ---------------- ---------------- Last First Middle STUDENT'S : SIGNATURE ------------------------------------- ---------------- Date STUDENT'S : ADDRESS --------------------------------------------------------- STUDENT'S : EMAIL --------------------------------------------------------- SCHOOL'S : NAME --------------------------------------------------------- Pick a four-digit number. GRADE : PIN : It will be used for your ------ -------- secure identification. 1st TEACHER'S : NAME ----------------- ---------------- ---------------- Last First Middle TEACHER'S : SIGNATURE ------------------------------------- ---------------- Date 2nd TEACHER'S : NAME ----------------- ---------------- ---------------- Last First Middle TEACHER'S : SIGNATURE ------------------------------------- ---------------- Date SCHOOL'S OFFICIAL : STAMP ------------------------------------- ------------------------------------------------------------------------ Please feel free to make photocopies of this form if necessary. ------------------------------------------------------------------------