2020 LPSEF Exhibitor Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

School *

Name of Student

Name of Parent(s)

Home Phone #

Student Email Address

Parent Email Address

Student Home Address (City, State, Zip)

Grade Level

Clear selection

Gender

Male

Female

Clear selection

Date of Birth

YYYY

Ethnicity (check all that apply)

African American

Asian Indian

Asian Pacific

Caucasian

Hispanic

Native American

Other:

Project Title

Individual or Partenered Project

Individual

Partnered

Clear selection

If partnered:

List the names of all group members

Category

Animal Science (AnS)

Behavioral and Social Sciences (BSS)

Chemistry (Ch)

Earth and Planetary Sciences (EPS)

Energy and Transportation (ET)

Engineering (Eng)

Environmental Sciences (Env)

Math and Computer Sciences (MC)

Medicine and Health Sciences (MH)

Microbiology (Mb)

Physics (Ph)

Plant Sciences (PS)

Clear selection

Exhibit Needs

Electricity

Floor space only (no table)

Clear selection

Did this project require prior SRC/IRB approval?

Yes

Clear selection

If yes, check all that apply

Note: Potentially Hazardous Biological Agents include microorganisms (including bacteria, viruses, viroids, prions, rickettsia, fungi & parasites), recombinant DNA (rDNA) technologies or human or animal fresh/frozen tissues, blood, or body fluids. Hazardous Chemicals, Activities or Devices includes DEA-controlled substances, prescription drugs, alcohol and tobacco, firearms and explosives, radiations, lasers, etc.

Human Subjects (Forms 1, 1A, Research Plan, 1B, and 4 with questionnaire/survey/instrument are mandatory; Forms 1C & 2, when applicable.)

Vertebrate Animals (Forms 1, 1A, Research Plan, 1B, 5A are mandatory; Form 2, when applicable.)

Potentially Hazardous Biological Agents (Forms 1, 1A, Research Plan, 1B are mandatory; Forms 1C, 2, 3 6A or 6B, when applicable).

Hazardous Chemicals, Activities or Devices (Forms 1, 1A, Research Plan, 1B, 3 are mandatory; Forms 1C & 2, when applicable.)

Will you be eating the chicken veggie burrito lunch provided by The Rio for $6?

YES

Clear selection

Will you be eating Wing Shack for $6?

Yes

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms