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Registration Form Please fill in the designated spaces for the information that is being asked for.

The information will be used to contact you, the participants, in case there will be important announcements regarding the contest. Please be reminded that only third to fourth year high school students will be allowed to participate in the contest. Please write legibly in print. Participating School School Address School Telephone No. School Fax No. Team 1 Name Coach Student Contestant 1 Student Contestant 2 Student Contestant 3 Team 2 Name Coach Student Contestant 1 Student Contestant 2 Student Contestant 3 If you are using a private vehicle, please indicate the Plate Number:_________________________ Please submit this Registration Form with the Photocopy or Scanned ID cards of the student Participants on or before December 12, 2011 (Monday) to confirm your teams participation in the contest. You may either fax back this form to Ms. Gina Mamuag, fax no. (632) 426-1323, Department Secretary of the Ateneo de Manila University Chemistry Department or send this form via electronic mail at achesacho2012@yahoo.com. Phone No. Email Address Phone No. Email Address

Ateneo Chemistry Society

Room 305, Manuel V. Pangilinan - Center for Student LeadershipAteneo de Manila University, Loyola Heights, Quezon City4266001 local 5430 | | http://aches.x10.mx

website: http://bit.ly/acho2012

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