REGISTRATION FORM for Super Saturday Science

October 13, 2007, 9 a.m. to noon

 

Name:                                                                                                           

 

Address:                                                                                                      

 

City:                                                                                                              

 

State:                                                 Zip:                                                 

 

e-mail address:                                                                                         

 

Daytime phone:                                                                                         

 

Grade in school:                                                                                         

 

 

Enclose $6 for each registration (or $10 for two) payable to UMM

 

q I need a scholarship for the registration fee

 

T-Shirt Size:

 

q Youth Large q Adult Small q Adult Medium q Adult Large

q Adult Extra Large

 

q I participated in Super Saturday Science in 2005

q I participated in Plan It Green in 2007

 

I hereby waive and release Super Saturday Science and University of Minnesota Morris from any and all liability from any damages or injuries while participating in any activities. I agree to allow Super Saturday Science to use any photos of my children for publicity purposes.

 

Parent's signature / date: ________________________________________________________________________________

 

 

Please print out this form and mail completed form & payment to:

 

                        Sharon Papiernik

                        USDA-ARS-MWA

                        North Central Soil Conservation Research Lab

                        803 Iowa Avenue

                        Morris, MN 56267