ICK! Registration Form 2014
<b>Date: </b>         Saturday, April 26, 2014

<b>Location:</b>    ITC (Innovative Technologies Complex) at Binghamton University
                   85 Murray Hill Rd.
                   Binghamton, NY 13905

<b> Time: </b>       <u>Session 1</u>: 9am - 1pm
                  <u>Session 2</u>: 2pm - 6pm

<b>Cost:</b>         $20-Pay day of event by  cash or check
** Checks can be made payable to BU foundation with memo "Binghamton Bioengineers"

*If you have any questions regarding this form, feel free to contact us at binghamtonbioengineers@gmail.com!

A confirmation email will be sent to the indicated address within 1 week of registration.
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Session *
Child's Name *
Child's Grade *
Child's School District *
Contact Number *
Contact E-mail *
Any Allergies/Concerns?
Are you comfortable with your child being photographed? *
We use these photographs for social media purposes (we will not release any personal information of your child).
Would you like a shirt for your child?
Price: $12 (Before 4/11) or $15 (After 4/11)
Clear selection
If yes, what size?
Children will be randomly assigned to groups based on age. Do you have any requests for your child's group?
For example, if you would like siblings to be put in the same group, please specify here
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