New York State Science Olympiad Registration Form

Please complete the registration form and send it, with your CHECK for $175.00 payable to the NEW YORK STATE SCIENCE OLYMPIAD INC., to the address at the bottom of this page.  The registration fee is nonrefundable.              Purchase orders cannot be accepted for registration

School information:                       Check One:   ___ Division B (Grades 6-9)     ___ Division C (Grades 9-12)

        School Name: ________________________________________________________________

        Address: ____________________________________________________________

        City:   ________________________________  Zip Code: _______________________

        Telephone: (____)______________________ FAX: ( ____)_____________________

        Principal's Name ______________________________

Coach Information:*

Coach #1:         _____________________________    Email address __________________________

Home Address  _________________________________________________________

City _________________  State ____  Zip _______________  Home Phone (____)____________  
                                                                                                                                         (Do not enter school number)
Specific subjects taught: (do not enter science)  ______________________

Coach #2:         _____________________________    Email address __________________________

Home Phone (____)____________________      (Do not enter school number)

Specific subjects taught: (do not enter science)  ______________________

*There must be at least two coaches per team.  Coaches will assist in conducting the events at the regional and state events.

A FORM RECEIVED WITH BLANK SPACES WILL BE RETURNED WITHOUT PROCESSING.

Registrations received after Dec 31, 2000 will be accepted on a space available basis.

Mail registration and check to:  New York State Science Olympiad, 1 Lakeside Drive, Valhalla, NY 10595 1944