REGION 3 SCIENCE OLYMPIAD 2010 APPLICATION FORM North Louisiana Science Olympiad Region 3 Registration Form Details: http://ulm.edu/scienceolympiad/

This form should be completed by a school representative for each Division B (Grades 6-9) and Division C (Grades 9-12) team. If your school participates in both Division B and C, please complete a form for each team. Please complete and mail with a check made payable to ULM Science Olympiad for $35.00 to:

Dr. Gary L. Stringer, Head, Department of Geosciences, Hanna Hall 314A University of Louisiana at Monroe, Louisiana 71209-0550

Please circle the appropriate division:

Division B (Grades 6-9) Division C (Grades 9-12)

Teacher/ Coach ______School ______Street Address ______City ______Email address ______@ ______School Phone ______Home Phone ______FAX ______

I certify that I have sent the Science Olympiad membership form and appropriate fees to the Science Olympiad National Office and I plan to enter a school team in the Region 3 Science Olympiad to be held Saturday, March 6, 2010 on the ULM campus. I understand, the rule book will be sent to me by the National Office, and material specifically related to the Region 3 tournament will be sent to me by the University of Louisiana at Monroe.

Signed Name: ______Date: ______Printed Name: ______

/2010 STUDENT ROLL CALL FORM, SCIENCE OLYMPIAD 2010 North Louisiana Science Olympiad Region 3 Team Registration Form Details: http://ulm.edu/scienceolympiad/

Please make a finalized list of up to 15 students of your division's team by January 15, 2010. Please type or print legibly and mail this completed form to:

Dr. Gary L. Stringer, Head, Department of Geosciences, Hanna Hall 314A University of Louisiana at Monroe, Louisiana 71209-0550

Please circle the appropriate description of this list: Pending Tentative Finalized

1. ______Grade __ 2. ______Grade __ 3. ______Grade __ 4. ______Grade __ 5. ______Grade __ 6. ______Grade __ 7. ______Grade __ 8. ______Grade __ 9. ______Grade __ 10. ______Grade __ 11. ______Grade __ 12. ______Grade __ 13. ______Grade __ 14. ______Grade __ 15. ______Grade __

/2010