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					                    >Life in the Universe - NSC Entry Form


NATIONAL COMPETITION OF
SCHOOL OR ORGANISATION:
       Name
       Address
       Tel / Fax
       Email
Name or Designation of Team



Name(s) of Team Members



Type of work (artistic/scientific)
Format work presented in (cd-rom, essay…)
RESPONSIBLE ADULT:
        Name
        Status (Parent, Teacher, etc)
INDIVIDUAL PARTICIPANT:
        Full Name
        Address
        Tel / Fax/ Email
        Nationality
        Sex
        Date and Place of Birth
Relevant Health Information
(Health problems that may affect your participation in the
Super Prize travel activities must be mentioned here)
DETAILS OF PARENTS:
(For Pupils Only)
           Full Names
           Address (if other than above)
           Tel / Fax/ Email

CERTIFICATION BY TEACHER

I hereby declare that:

– I am the teacher of _______________________________
                                                    (Name of Participant)

– The selection of the existing material was done by the individual or group
as registered above, and

– All original material, design and layout was the work of the individual or
group

Signature _______________________________________



Place and Date ___________________________________
>Life in the Universe - NSC Entry Form

				
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posted:3/24/2011
language:English
pages:2
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