Phone number *

(###)

###

####

Fax number

(###)

###

####

Name of the person in charge *

First Name

Last Name

Name of the chaperon (if not the same as above)

First Name

Last Name

Participant #1 *

First Name

Last Name

Sex *

Male

Female

Date of birth *

MM

DD

YYYY

Participant #2

First Name

Last Name

Sex

Male

Female

Date of birth

MM

DD

YYYY

Category *

5th grade

6th grade

Sec. 1

Sec. 2 & 3

Sec. 4 & 5

Project presented in: *

E

F

I need an electric outlet for my project: *

Yes

No

We are in high school, want to be judged for the CWSF, and are available from May 15 to 20: *

Yes

No

Does the project involve the participation of humans or the use of animals? *

Yes

No

Will you be flying to Chibougamau? *

Yes

No

Arrival date:

MM

DD

YYYY

Arrival time:

Hour

Minute

Second

AM PM

Departure time:

Hour

Minute

Second

AM PM