2020 United States Regional Brain Bee Championship Competitor Registration Form
***Note***: The 2020 USA Brain Bee Championship has been postponed. For more information, visit https://www.dental.umaryland.edu/brainbee/championship/us-championship/.

For questions about the Championship, please contact the International Brain Bee coordinator, Dr. Norbert Myslinski at nmyslinski@umaryland.edu or 410-706-7258.
Brain Bee Chapter Information
State *
City *
Name of Chapter Brain Bee Competition *
Chapter Competition Date *
MM
/
DD
/
YYYY
Chapter Competition Place *
Competitor Information
Competitor Name *
Competitor Address *
Competitor E-mail *
Competitor Cell Phone Number *
High School *
High School E-mail *
Is the registrant a local winner, or a substitute? *
(Please attach a high definition head shot Photo and short Biography with interesting information not included above, 100 to 200 words. It is preferred that they be sent in electronic format to nmyslinski@umaryland.edu)
Chaperone Information
Competitor must be accompanied by a chaperone.
Chaperone Name *
Relationship to the Competitor *
Chaperone Address *
Chaperone E-mail *
Chaperone Cell Phone Number *
Other Accompanying Persons
News media (print, radio, TV, internet) where press release should be sent (name and e-mail address)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy