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2020 United States Regional Brain Bee Championship Competitor Registration Form
***Note***: The 2020 USA Brain Bee Championship has been postponed. For more information, visit
https://www.dental.umaryland.edu/brainbee/championship/us-championship/
.
For questions about the Championship, please contact the International Brain Bee coordinator, Dr. Norbert Myslinski at
nmyslinski@umaryland.edu
or 410-706-7258.
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* Indicates required question
Brain Bee Chapter Information
State
*
Choose
AK
AL
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
City
*
Your answer
Name of Chapter Brain Bee Competition
*
Your answer
Chapter Competition Date
*
MM
/
DD
/
YYYY
Chapter Competition Place
*
Your answer
Competitor Information
Competitor Name
*
Your answer
Competitor Address
*
Your answer
Competitor E-mail
*
Your answer
Competitor Cell Phone Number
*
Your answer
High School
*
Your answer
High School E-mail
*
Your answer
Is the registrant a local winner, or a substitute?
*
Local Winner
Substitute
(Please attach a high definition head shot Photo and short Biography with interesting information not included above, 100 to 200 words. It is preferred that they be sent in electronic format to
nmyslinski@umaryland.edu
)
Chaperone Information
Competitor must be accompanied by a chaperone.
Chaperone Name
*
Your answer
Relationship to the Competitor
*
Your answer
Chaperone Address
*
Your answer
Chaperone E-mail
*
Your answer
Chaperone Cell Phone Number
*
Your answer
Other Accompanying Persons
Your answer
News media (print, radio, TV, internet) where press release should be sent (name and e-mail address)
Your answer
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