SCHOOL MEMBERSHIP FORM

2012 Montana Science Olympiad
Tuesday - November 20, 2012

Montana State University

To register your team for the Montana Science Olympiad, please print this membership form and fax to 406-994-3733 or mail to the below address. Your school membership application is due in our office by Friday, October 19, 2012.  A school purchase order needs accompany the membership application.  YOUR CHECK MAY FOLLOW and is due at the Science Olympiad Office by Wednesday, October 24th.   Please make check(s) payable to: Science Math Resource Center . 

Science/Math Resource Center
ATTN: Ben Kinsella, State Coordinator
401 Linfield Hall, MSU, Bozeman , MT 59717

Phone: 406-994-7476 or 800-455-7837

Fax: 406-994-3733

email:  mtscioly@gmail.com

Please Check:	Please Check:
Division B (Grades 6-9)	Division C (Grades 9-12)
$325 Team of 11-15 students ___ $325 JV Team of 11-15 students (not eligible to medal)	___ $325 Team of 11-15 students ___ $325 JV Team of 11-15 students (not eligible to medal)
___ $275 Team of 10 or less students ___ $275 JV Team of 10 or less students (not eligible to medal)	___ $275 Team of 10 or less students ___ $275 JV Team of 10 or less students (not eligible to medal)
# of students enrolled in your school Sept 2012 Important! Determines small school status for awards	___# of students enrolled in your school Sept 2012 Important! Determines small school status for awards

Coach Name

School

School Address

City & Zip

Phone and

email

Each school may send a JV team for Division B and/or C .

Note: JV teams will be scored for each event they enter, but their scores will not be used to determine medals
and State placement.

If you fax (406-994-3733) this form, please call to verify that we have received it.
(Toll free phone: 800-455-7837 or 406-994-7476)