American History Bee

Contestants: 8th Grade Students from WNY

Saturday, April 23, 2016 2:00 pm
The Buffalo History Museum 1 Museum Drive Buffalo, NY 14216
Students Name : _______________________________________________________________________
Address : _____________________________________________________________________________
City: _______________________ Zip:_______________ Phone number: __________________________
School:_______________________________________________

Student must be in 8th grade

Parents/Guardians e-mail: ________________________________________________________________

** Attach a copy of your current report card to verify your school and current grade. **
All items need to be completed, submit a copy of your report card and parental/guardian signature , all
needed for the application to be considered complete.
Please mail back to American History Bee c/o 1074 Elmwood Avenue,Buffalo,N.Y. 14222

Pre-registration is required and limited to 25 participants.

Pre-register

by

April 15,2016

You will be notified by e-mail on 4 / 20 / 16 if you are among the first 25 participants
with a completed application.
If you need additional applications, please photocopy it yourself or call Councilman Joseph Golombeks
office at 851-5116 for additional copies.
I/We GRANT permission for this student to participate in the American History Bee. We grant permission
for this students photo/image, name and school to be used for publicity purposes. No other information
will be released without written consent from me as parent or guardian.

Print name of Parent/Guardian (print):_______________________________________________________

Signature of Parent/Guardian (sign):________________________________________________________
Relation to student: ______________________________________ Date:_________________________

Trophies and prizes to the 1st, 2nd and 3rd place finishers. Trophy to the school of the 1st
place winner. Plenty of door prizes as well.
Larry Patti, President, Forest District Civic Association
10 74 Elmwood Avenue Buffalo, New York 14222 Email: elmwoodprintout@aol.com (716) 884 - 5550