2019 LPSEF Exhibitor Registration
Name of Student
Home Phone #
Student Email Address
Student Home Address (City, State, Zip)
Date of Birth
Ethnicity (check all that apply)
Individual or Partenered Project
List the names of all group members
Animal Science (AnS)
Behavioral and Health Sciences (BSS)
Earth and Planetary Sciences (EPS)
Energy and Transportation (ET)
Environmental Sciences (Env)
Math and Computer Sciences (MC)
Medicine and Health Sciences (MH)
Plant Sciences (PS)
Floor space only (no table)
Did this project require prior SRC/IRB approval?
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.)
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