History Day Registration Forms
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COVER SHEET:

MISSISSIPPI HISTORY DAY COMPETITION 2004

FEE: $10.00 for each STUDENT CONTESTANT and STUDENT SPECTATOR.
THERE IS NO FEE FOR TEACHERS OR CHAPERONES.

* Please print or type this sheet; illegible entries cannot be considered.

* Please make additional copies of this sheet FOR EACH ENTRY.

Student's name:_________________________________________________

Student’s home address___________________________________________

Name of parents/guardians________________________________________

Student's telephone number_______________________________________

Name of school_________________________________________________

Title of entry___________________________________________________

Check one: Junior High_________ Senior High___________ Middle School_____

Category:

(Check ONLY one; refer to the Contest Guide for official categories.)

_____Paper _________Individual Exhibit ___________Group Exhibit

_____Individual Performance __________Group Performance _________Quiz Bowl

_____Individual Documentary (Media) ____________Group Documentary (Media)

Name of your history club or Junior Historical Society________________________

Sponsor's name_______________________________________________________

Sponsor's address and phone number_______________________________________

I hereby submit that my entry is my own work and that I have been informed that it must
follow the guidelines set forth by both National and Mississippi History Day regulations.

Student’s signature_____________________________________________________

Date________________________________________________________________

DIRECTIONS FOR COMPLETING YOUR
HISTORY DAY REGISTRATION:

PAPERS:

ATTACH THIS COMPLETED COVER SHEET TO YOUR ESSAY AND MAIL ALONG WITH TWO COPIES OF YOUR WORK TO THE
ADDRESS BELOW BY February 25, 2004.

IF YOUR PAPER IS POSTMARKED BY February 25, 2004, IT IS ON TIME. PAPERS WILL NOT BE RETURNED; KEEP A COPY FOR YOURSELF.

ALL OTHER CATEGORIES OF COMPETITION:

COMPLETE THE COVER SHEET AND MAIL BY February 25, 2004.
(THE COVER SHEETS ENABLE US TO FIND OUT HOW MANY
STUDENTS PLAN TO COMPETE. IF WE RECEIVE A LARGE NUMBER, WE WILL NEED TIME TO FIND ADDITIONAL JUDGES AS WELL AS ADDITIONAL ROOMS.)

THANKS FOR YOUR HELP!

Email the forms to us at Mary.Farrell@usm.edu
OR
Send your forms via post to:
HISTORY DAY IN MISSISSIPPI
UNIVERSITY OF SOUTHERN MISSISSIPPI
BOX 5047
HATTIESBURG, MS 39406-5047
FAX: 266-4334


Please call if you have any questions or if you have any last-minute changes to entry titles or contestants.!

Mary Beth Farrell:
Office 601-266-4335 (Please leave a voice mail message.)
Home 601-544-5311
email: mary.farrell@usm.edu

REGISTRATION FORM:

HISTORY DAY IN MISSISSIPPI 2004
Please return this form no
later than February 25, 2004 to:

History Day in Mississippi,
University of Southern Mississippi,
Box 5047, Hattiesburg, MS 39406.
Or fax it to Mary Beth Farrell at 601-266-4334.

YES, OUR SCHOOL WILL ATTEND HISTORY DAY AT THE
UNIVERSITY OF SOUTHERN MISSISSIPPI
scheduled for March 6, 2004!

Teacher's name__________________________________________

Home phone____________________ School phone______________

Email__________________________ Fax____________________

Number planning to attend (please include chaperons.)______________

We will be eating in the University Commons.___________

We will be eating off-campus.________________________

My group includes students with special needs. ___________
(If so, please let us know what we can do to help.)

IMPORTANT:
On the back of this page, please type or print the names and Social Security Numbers of all students who plan to attend as either spectators or competitors.

We will need this list by February 25, 2004 for insurance purposes.
Attach an extra sheet if needed.
Please call if you have any last-minute additions.