Regional Registration Form A: Senior Division Regional Registration Form A for Senior Division Projects This completed form is required for all Senior Division Student Projects. Due by January 25, 2021. Please send a nonrefundable $35 registration fee for each participant. If the student lives outside the greater Capital Region (please see the rules for a list of counties), the fee is $50. Save your copy! Make all checks out to GCRSEF, Inc. Send all checks and forms to: Ms. Fran Lohnes, Saratoga Springs High School, 1 Blue Streak Blvd., Saratoga Springs, NY 12866 Student’s First Name * Student’s Middle Name * Student’s Last Name * Gender * Date of Birth * Student’s Grade * 9th 10th 11th 12th Is the above named student a citizen of the United States? * Yes No Student T-Shirt Size * Select Small Medium Large Extra-Large None Student Contact Information Home Address * Home Address Home Address Home Address City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Zip Home or Cell Number * Student’s Email Address * Confirm Student’s Email Address * Confirm Email Address Parent/Guardian First Name * Parent/Guardian Last Name * Parent/Guardian Email Address * Confirm Parent/Guardian Email Address * Confirm Email Address Project Details Number of Years Competing in the Fair * Includes this year. Project Category * Animal Sciences (ANIM) Behavioral and Social Sciences (BEHA) Biochemistry (BCHM) Biomedical and Health Sciences (BMED) Biomedical Engineering (ENBM) Chemistry (CHEM) Computational Biology and Bioinformatics (CBIO) Earth and Environmental Sciences (EAEV) Embedded Systems (EBED) Energy: Chemical (EGCH) Energy: Physical (EGPH) Engineering Mechanics (ENMC) Environmental Engineering (ENEV) Materials Science (MATS) Mathematics (MATH) Microbiology (MCRO) Physics and Astronomy (PHYS) Plant Sciences (PLNT) Robotics and Intelligent Machines (ROBO) Systems Software (SOFT) Translational Medical Sciences (TMED) Cellular and Molecular Biology (CELL) Is This a Team Project * Yes No Team Project Leader * Other Team Members(s) * Project Title – Maximum 25 Words * Does Your Project Require Prior SRC/IRB Approval? * Yes No Does Your Project Involve Vertebrate Animals? * Yes No Does Your Project Involve Human Subjects? * Yes No School District Name * School Building Name * Select Academy of Holy Names Broadalbin-Perth High School Bright Hope Academy High School Burnt Hills – Ballston Lake High School Columbia High School Greenwich Central High School Guilderland High School Home-school Hudson Falls High School Monroe Woodbury High School Newburgh Free Academy High School Newburgh Free Academy North Campus Niskayuna High School Nyack High School Rondout Valley High School Saratoga Springs High School Shaker High School Taconic Hills High School Tappan Zee High School Valley Central High School Warwick Valley High School Other School Building Name Number of Sponsoring Teachers * 1 2 3 If your project is under the sponsorship of more than one teacher, please select the appropriate number of teachers you wish to register under. First Sponsoring Teacher’s First Name * First Sponsoring Teacher’s Last Name * First Sponsoring Teacher’s Email * Confirm First Sponsoring Teacher’s Email * Confirm teacher email address Second Sponsoring Teacher’s First Name * Second Sponsoring Teacher’s Last Name * Second Sponsoring Teacher’s Email * Confirm Second Sponsoring Teacher’s Email * Confirm teacher email address Third Sponsoring Teacher’s First Name * Third Sponsoring Teacher’s Last Name * Third Sponsoring Teacher’s Email * Confirm Third Sponsoring Teacher’s Email * Confirm teacher email address Lunch Preference * Select Ham Roast Beef Tuna Turkey Vegan Electronic Signature * I Hereby Sign By checking this box, you are creating an electronic signature. Submit If you are human, leave this field blank.