Wayne County Science Olympiad

Sponsored by the Tau Beta Pi Engineering Honor Society - Michigan Iota Chapter and the University of Michigan - Dearborn

Pond in front of the Administration Building

Register for the Coaches Clinic of America 2009 cancel

Personal Information

Registration ID
Title		First Name		Last Name		Suffix
Job Title
Email
Alternate Email

School Information

Name
Division	B (Middle School) C (High School)
District
Address1
Address2
City		State		Zip
Phone
Fax

Home Information

Address1
Address2
City		State		Zip
Home Phone
Mobile Phone

Clinic Information

Friday Dinner	Yes No
Vegetarian	Yes No
Other Please Specify

Administrative Information

Date Application Rec'd		Confirmation
Date Check Rec'd		Check Amount
Name on Check		Check Number

The cost of the clinic is $140. Please make checks payable to "University of Michigan Dearborn" and mail a copy of the form with the payment to:

  Wayne County Science Olympiad
  P.O. Box 23152
  Dearborn, MI 48123