2019 LPSEF Exhibitor Registration
School *
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Name of Student
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Home Phone #
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Student Email Address
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Student Home Address (City, State, Zip)
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Grade Level
Date of Birth
Ethnicity (check all that apply)
Project Title
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Individual or Partenered Project
If partnered:
List the names of all group members
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Exhibit Needs
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.
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