Pleaseprint Legiblyorfillinthisformelectronically. Fillout Oneregistrationformfor

2017BLUERIDGEHIGHLANDSREGIONALSCIENCEFAIRREGISTRATIONFORMPETERSGYM,RADFORDUNIVERSITY,MARCH 2-3, 2018

Pleaseprint legiblyorfillinthisformelectronically. Fillout oneregistrationformfor eachstudent.Theform must bereceivedbyChrisBibeaubyFebruary19, 2018.

Individualproject

Team project Number ofTeam members

Name ofstudent:

Email:

Phone number:

Home address:

City:

State:Zip:

SchoolGrade

SchoolAddress:

City:

State:

Zip:

AreyouaU.S.Citizen?YesNo

Gender:Male

Female

Exact Title ofExhibit

Name ofAdultSponsor (Must bethesameasshownonApprovalForm1A)

Email:

PhoneNumber:

Categoryinwhichexhibitwill beentered(checkone):

AnimalSciences

BehavioralandSocialSciencesBiochemistry

BiomedicalandHealthSciencesBiomedicalEngineering

CellularandMolecularBiologyChemistry

ComputationalBiologyBioinformaticsEarthandEnvironmentalSciencesEmbeddedSystems

Energy:Chemical

Energy:PhysicalEngineeringMechanicsEnvironmentalEngineeringMaterialsScienceMathematics

Microbiology

PhysicsandAstronomyPlantSciences

RoboticsandIntelligentMachinesSystemsSoftware

TranslationalMedicalScience

RADFORDUNIVERSITYRADFORD,VIRGINIA

ModelRelease Agreement (for useofimageoutsideof RadfordUniversity)

Bymychild’sparticipationinthisfair,IherebyagreethattheimagestakenofmychildmaybeusedbytheBlueRidgeHighlandsRegionalScienceFairandRadfordUniversityforpromotionoftheboth the science fair andRadfordUniversity.

IfurtherunderstandthattheUniversityshallownallrightstotheseimages.Theserightsshallinclude economicand propertyrightsaswellas the right to copyrightthese materials.

PrintStudent’sName

SignatureDate

PrintParent/Guardian Name

Parent/GuardianSignatureDate

FORMSCHECKLIST

FormsforAllStudentsAbstractFormRegistrationFormResearchPlan

ChecklistforAdult Sponsor (1)Student Checklist (1A)ApprovalForm (1B)

Ifyourprojectinvolvesanyofthefollowing,youneedtheassociatedforms.Eachoftheseprojectsrequirespriorapprovalbytheappropriateauthorities(InstitutionalReviewBoardorScientificReviewCommittee).Ifyouhavequestionsconcerningtheseforms,pleaseemail Mr.ChrisBibeauat .

Projectscontinuedfrompreviousyear:

ContinuationProjectsForm (7)

Hazardouschemicals,activitiesor devices, DEA-controlled substances:

RiskAssessment Form (3)

QualifiedScientist Form (2),ifapplicable

HumanParticipants

HumanParticipantsForm (4)SampleofInformedConsentForm

QualifiedScientist Form (2), ifapplicable

VertebrateAnimals

VertebrateAnimalForm (5A)

QualifiedScientist Form (2), ifapplicable

VertebrateAnimalForm (5B), ifperformedatRegulatedResearchInstitution

PotentiallyHazardousBiologicalAgents

RiskAssessment (3)

PHBARiskAssessment Form (6A)

HumanandVertebrateAnimalTissueForm (6B)

Workconductedin aregulatedresearchinstitutionor industrialsetting

RegulatedResearchInstitutional/IndustrialSettingForm (1C)

FORMSMUSTBERECEIVEDATTHEADDRESSGIVENBELOWBYFEBRUARY19,2018.OTHERWISE,YOUMAY NOTBEALLOWEDTOPARTICIPATE.

Mr.ChrisBibeau,ScientificReviewCommitteeChairBlueRidgeHighlandsRegionalScienceFair

Box6949,ChemistryDepartment

RadfordUniversity,Radford, Virginia24142

Display

Alldisplaysmustfollowtheruleslaidoutbelow.FairOfficialswillcheckalldisplaysforthefollowingaftersetuponFriday,March2. Anyviolationsmayleadtodisqualificationoftheproject.

Displaysmust bewithindimensionallimits–33”deepby48”wideby108”high(from thefloor)

Displaysmustinclude avisiblecopyofthe AbstractForm(Fairorganizerswillposta copyofthesubmittedAbstractForm at eachdisplaylocation).

Displaysmust NOTcontainanyof thefollowing:

• Livingorganisms
• Soil,sand, rock,and/orwastesamples
• Preservedanimalspecimens
• Humanor animalfood
• Human/animalpartsorbody fluids
• Plantmaterials
• Chemicals(includingwater)
• Hazardoussubstances ordevices
• Dryiceorother sublimatingsolids
• Sharporglassitems
• Flamesor highlyflammablematerials
• Batterieswithopen-top cells
• Awards,medals, businesscards,flags, logos, CDs,DVDs,flashdrives,brochures,booklets, endorsements, or acknowledgements
• Visualdepictionsofvertebrateanimalsduringlabprocedures
• Contact information ofstudent

Allphotosofidentifiablehumansubjectsotherthanthestudentpresentersmustbeaccompaniedbysignedreleaseforms.

Allimages(includingphotos,graphics,andgraphs)mustbecredited.Imagescreatedbythestudent must belabeledassuch.