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Local and Regional Science Fair Award Request Form
** You must be an APS Member in good standing **
APS Judge:
Institution:
Address
City, State, Zip
Email Address:
Phone Number:
Name of Science Fair:
Location of Science Fair:
Date and Time of Science Fair:
Estimated number of participants:
Science Fair Coordinator:
Science Fair Coordinator Email:
Name of School (if applicable):
School Address:
City, State, Zip
If this an annual affair do you plan to participate annually?

The American Physiological Society
Education Office
9650 Rockville Pike, Bethesda, MD 20814
(301) 634-7132  Email: education@the-aps.org
Web: http://www.the-aps.org/education