New  Jersey  Academy  of  Science

Science for Breakfast Registration Form

       Science for Breakfast

Sponsored By

THE NEW JERSEY ACADEMY OF SCIENCE

In Partnership With

Richard Stockton College of New Jersey

SATURDAY, APRIL 22, 2006, 9:00 AM TO 12 NOON

At

Richard Stockton College, G-wing Cafeteria, Pomona NJ

 This event is for high school students interested in pursuing careers in science.  Breakfast table discussions with Scientists and Researchers will focus on the various aspects of being a Professional Scientist.

Teachers:  If you are recommending a student to participate in Science for Breakfast and will be attending personally, please note that fact in the comment section below.

Print this form, complete it, and fax it to the NJAS office at 1-732-463-0511.

Or

Cut and paste this form into an email and send to the NJAS Office at njacadsc@rci.rutgers.edu.

DEADLINE FOR REGISTRATION IS April 8, 2006

Name of Student

 

Present Grade

 

Name of High School

 

          Address 1

 

          Address 2

 

Name of Advisor / Teacher

 

         Email (Please print clearly)

 

Student’s Field(s) of Interest

 

How did you learn of this event?

 

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