Phone number *

(###)

###

####

Fax number

(###)

###

####

Name of contact person *

First Name

Last Name

Name of the chaperon (if different than contact)

First Name

Last Name

Chaperon cell phone number

(###)

###

####

Participant #1 *

First Name

Last Name

Sex *

M

F

Date of birth *

MM

DD

YYYY

Participant #2

First Name

Last Name

Sex

M

F

Date of birth

MM

DD

YYYY

The project will be presented : *

in English

in French

Category *

5

6

Sec1 (1.0 and 1.1)

Sec2_3 (1.2 and 2.1)

Sec4_5 (2.2 and 2.3)

I need an electric outlet for my project: *

Yes

No

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

Yes

No

We are in high school. Want to be judged for the CWSF and are available from May 11th to 19th 2019. *

Yes

No

We are 15 years old or older, are available from September 21 to 28, 2019 and woul like to be judged for the International Science Fair.

Yes

No

Schools from the South will travel by charter on the morning of March 26th. Please indicate from what airport you will leave:

Montréal

Québec

Val-d’Or

Arrival date:

MM

DD

YYYY

Time of arrival in Kuujjuaq:

Hour

Minute

Second

AM PM

Departure date from Kuujjuaq:

MM

DD

YYYY

Time of departure from Kuujjuaq:

Hour

Minute

Second

AM PM