*Title: Dr. Mr. Ms. Mrs.
   Others: If your are in the military, type your rank before your FIRST NAME in the space below.

*First Name:

*Last Name:

*Classification: Select One Student Faculty/Staff Other

*Mailing Address:

*City: *State: *ZIP:

*Telephone Number:

Fax Number:

*E-mail Address:

*Please check the following Fairs you would like to judge:
    (you may choose more than one)

:Region I Science Fair-Elementary  :Region I Science Fair-Secondary

:State Science Fair

*Please select your category 1st Choice: Select One 0100 Behavioral and Social Sciences 0200 Biochemistry 0300 Botany 0400 Chemistry 0500 Earth, Space, and Environmental Sciences 0600 Engineering, Computers, and Mathematics 0700 Medicine & Health 0800 Microbiology 0900 Physics 1000 Zoology

*Please select your category 2nd Choice: Select One 0100 Behavioral and Social Sciences 0200 Biochemistry 0300 Botany 0400 Chemistry 0500 Earth, Space, and Environmental Sciences 0600 Engineering, Computers, and Mathematics 0700 Medicine & Health 0800 Microbiology 0900 Physics 1000 Zoology

*Please select your category 3rd Choice: Select One 0100 Behavioral and Social Sciences 0200 Biochemistry 0300 Botany 0400 Chemistry 0500 Earth, Space, and Environmental Sciences 0600 Engineering, Computers, and Mathematics 0700 Medicine & Health 0800 Microbiology 0900 Physics 1000 Zoology