The JPL Annual Invention Challenge is ready for its tenth year. The
title for this year's contest is the **Play a Song Contest**. The
objective and rules are listed below. Questions related to this contest
should be directed to: Paul MacNeal at: work phone (818)354-7824, FAX
(818)393-5239, M/S 301-486, located in Building 301-475SS, or e-mail to
<paul.d.macneal@jpl.nasa.gov>.

OBJECTIVE: Create a device that is capable of performing two tasks. The
first task is to replicate a C Major scale. The second task is to play
at least the first ten notes of a recognizable song of your choice in
proper pitch, tempo, and meter. No electronic speakers or electronically
produced or amplified sounds are permitted. Points will be awarded for
overall appearance, overall creativity, task 1, and task 2 with a total
possible point count of 100 points. The winner of the contest will be
the person/team whose device receives the highest number of points. 

[Rules]{.underline}:

ELIGIBILITY

1)  The contest is open to all JPL employees, contractors, and immediate
    family members. The contest is also open to teams of students from
    Southern California middle schools and high schools providing that
    they have completed all required forms as outlined in rule 3 and 4
    below.

REGISTRATION -- JPL PERSONNEL

2)  Applications for JPL employees, contractors, and immediate family
    members entering the contest must be filled out and submitted to
    Public Services prior to midnight November 21, 2007. Completed entry
    forms should be directed to Public Services at FAX (818)393-4641, or
    sent via email to <Margaret.R.Porter@jpl.nasa.gov>. An entry form is
    included at the end of the rules. All entries will be time stamped
    based upon the time received. Only the first 20 JPL/contractor
    entries will be permitted to compete. Five alternates will be
    accepted in case some entries withdraw prior to the competition.

> JPL employee family members and friends are welcome to watch the
> contest, but must be cleared through the security office prior to
> arrival. JPL employees must fill out the visitor request form as found
> in the link... <http://eis/international/visitrequest.html>.

REGISTRATION -- SCHOOLS

3)  In order to streamline the paperwork process at JPL, each team must
    **mail** their completed student team entry form (attached)
    [and]{.underline} the "Authorization and Release for Photos and/or
    Video Recording" agreement form (attached) [for each person planning
    to attend the JPL contest]{.underline}. Each video release form must
    be completely filled out and signed. If the student is under 18
    years of age, then their parent or guardian must also sign. **The
    entire set of forms must be filled out and submitted to Public
    Services no earlier than September 10, 2007 and be postmarked no
    later than midnight October 5, 2007. Completed forms must be mailed
    to Public Services at Jet Propulsion Laboratory, M/S 186-113, 4800
    Oak Grove Drive, Pasadena, CA 91109.** All entries will be time
    stamped based upon the time received. Student teams will be notified
    to verify their acceptance into the contest by October 9, 2007.
    Questions regarding the entry forms can be directed to Maggie Porter
    in Public Services at (818)354-0112. Each school is allowed no more
    than three teams. Internal school competitions are encouraged to
    select the top three teams if necessary.

> Any foreign student (18 or over) or adult will need a special form
> filled out, which is processed by the Public Services Office.  The
> process takes nearly three weeks, therefore, if you plan on attending
> the contest at JPL, and you are a foreign national, it is important
> that you contact Public Services prior to November 1, 2007.
>
> **Additions or corrections to the registration forms and/or photo
> release forms need to be mailed to the Public Services Office with a
> postmark no later than Thursday, November 20, 2007.  FAX'd forms are
> not allowed. Failure to send in the signed video release form by the
> requisite time will prevent participation and access to the JPL
> contest for those students that fail to comply with this request.**

SPECIAL RULES FOR SCHOOL TEAMS

4\) Only the first 75 student team entries will be permitted to compete
at the regional competitions. Student teams will compete at a regional
competition held on Saturday, November 17, 2007 at California State
University in Fullerton or Manual Arts High School in Los Angeles.
Details for the regional competitions will be sent to all registered
teams. The top five winners of each regional competition will be invited
to compete at the JPL contest held on Friday, November 30, 2007 (see
Rule 5 below). In addition, the next closest ten entries between both
regional competitions will be invited to compete at the JPL contest.

LOGISTICS

5\) The contest date and time is Friday, November 30, 2007 between 11:30
AM and 1:00 PM. The contest is held at the Jet Propulsion Laboratory,
4800 Oak Grove Drive, Pasadena, CA 91109. The contest area is located
north of the fountain area, in front of the Administration Building
(Bldg. 180) steps. The contest will be held rain or shine. Check-in for
the event will begin at 10:15 AM.

DEVICE RULES

6)  The device must have the following characteristics:

```{=html}
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```
a)  Be a mechanically operated musical device that can produce
    reasonably loud, quality notes of good tone and resonance.

b)  Be capable completing Task 1, which is to produce an ascending C
    Major scale, starting with middle C (reference 261.63 Hz). The time
    to complete Task 1 must be between 5 and 15 seconds. If you choose,
    you can start either an octave above middle C (reference 523.25 Hz)
    or an octave below middle C (reference 130.81 Hz).

c)  Be capable completing Task 2, which is to replicate at least the
    first ten notes of a recognizable song (sheet music to be provided
    to the judges prior to starting this task) with proper tone, tempo,
    and meter in greater than 5 seconds and less than 20 seconds.

d)  Be initiated by a single operation (cut a string, flick a switch,
    pull a pin, etc) provided by the contestant for each task.  No human
    power may be used to add dynamic or potential energy to produce the
    musical notes. The device may be reset prior to the start of Task 2.

e)  Be physically no wider than 2.50 meters \[98 inches\], or longer
    than 2.50 meters \[98 inches\], or taller than 3.00 meters \[118
    inches\]. These dimensions are strictly enforced at the beginning of
    each task.

f)  Be able to adapt to uneven ground. See Rule 7 for details of the
    Contest Site.

g)  Not use any remote control devices.

h)  Not be a commercially purchased music box.

i)  Not utilize any electronic speakers or electronically produced or
    amplified sounds.

j)  There are no weight restrictions.

k)  The device may use existing musical instruments (except for music
    boxes).

l)  All construction materials are acceptable, except that no
    explosives, caustic chemicals, or other materials that might cause
    personal injury are allowed.

m)  Utilize safe energy sources. Examples of unsafe energy sources are
    chemical explosions and high pressure gas systems. Questionable
    sources must be cleared through Paul MacNeal and the Safety
    Coordinator prior to performing. Electrical power from a standard
    120 V source (15 amps maximum) is allowed.  The electrical cord may
    extend beyond the size as specified in Rule 6e.

CONTEST FACILITY DESCRIPTION

7)  The contest site is outdoors in front of Building 180. The ground is
    made from concrete and has a slight slope. Three operating sites
    will be utilized. The contestant will be randomly assigned to either
    Area 1, Area 2, or Area 3.

SCORING

8)  In many of the previous Invention Challenge Contests, scoring has
    been a relatively straight-forward system. This year, a major
    challenge for the teams is to strive for a high score based on the
    judging criteria below. Creativity will be awarded, as well as
    artistic appearance. Please consider these extra attributes as
    design requirements. The criteria have been reviewed by many
    individuals and are as clear and concise as can be reasonably
    expected. As is always the case, the judge's decision is final and
    is not subject to question. Good luck.

Points are awarded as follows:

a.  The maximum allowed total of points that can be accumulated is 100
    points.

b.  Points for general appearance and functionality of device (25 points
    maximum)

    i.  Appearance of device (10 points maximum)

        1.  A graduated range of points from 0 to 10 depending on
            whether or not the device appears to be attractive. Features
            such as a well-made, colorful, and visually striking will be
            awarded more points than features that show poor
            workmanship, visually plain, and dull.

    ii. Creativity of device (15 points maximum)

        1.  A graduated range of points from 0 to 15 depending on
            whether or not the device is an invention that has combined
            traditional or new musical instruments with a clever and
            unique way of mechanically operating the device. Please
            refer to a two minute video available on the Internet that
            shows a computer generated graphic video,
            <http://www.youtube.com/watch?v=FtkjuchHFn4>, of a very
            unique musical invention to get an idea of what is meant by
            awesome creativity.

c.  Points for Task 1 (40 points maximum)

    i.  Timeliness of completing the C major Scale is a requirement.
        Task 1 is considered a failure if the task is completed sooner
        than 5 seconds or later than 15 seconds. No points will be
        awarded for Task 1 if the time requirement is not met.

    ii. Loudness of the notes (15 points maximum)

        1.  A graduated range of points from 5 to 15 is awarded for
            notes that are heard from the device without using an
            optionally supplied microphone. The full 15 points can be
            awarded if the notes are clearly heard by members of the
            crowd up to 30 feet away from the device. Five (5) points
            can be awarded if the notes can be heard by a judge standing
            only 5 feet away from the device. If the device makes
            unwanted sounds (loud motors, loud compressors, loud
            squeaks, etc), then the ability to hear the
            [notes]{.underline} will be diminished. These types of
            diminishing features will be taken into account when
            awarding points in this category. The points awarded in this
            category are subjective and the judges' decisions are final.
            For the benefit of the audience (and with no penalty for
            points awarded in this category), the contestant is
            encouraged to use the optionally supplied microphone for
            devices that are barely audible at a distance of 5 feet from
            the device.

        2.  0 points will be awarded in this category if the notes are
            not audible beyond 5 feet from the device. In this case, the
            contestant is encouraged to use the optionally supplied
            microphone so that points in other categories may be
            awarded.

    iii. Accuracy of the notes (tone) (15 points maximum)

         1.  15 points if all notes are accurate to the C Major scale.
             Judges' decisions are final. Accuracy can be defined as a
             note that deviates less than a half tone from the
             prescribed tone. A C major scale contains notes of C, D E,
             F, G, A, B, and C.

         2.  10 points if only one note is out-of-tune or

         3.  5 points if two to three notes are out of tune or

         4.  0 points if more than three notes are out of tune.

    iv. Quality of the notes (resonance) (10 points maximum)

        1.  10 points if the notes sound clear and hold their tone
            reasonably long (0.5 seconds is sufficient), or

        2.  5 points if the notes are either clear or hold their tone
            for a long period, or

        3.  0 points if the notes are not clear and heavily damped out
            (muffled).

d.  Points for Task 2 (35 points maximum)

    i.  Timeliness of completing the first ten notes of the song is a
        requirement. Task 2 is considered a failure if the first ten
        notes are completed sooner than 5 seconds or later than 20
        seconds. No points will be awarded for Task 2 if the time
        requirement is not met. Please note that remaining notes in the
        song can take longer with a maximum playing time of 60 seconds.

    ii. Intonation of the song (10 points maximum)

        1.  Sheet music needs to be handed to the judges prior to the
            start of Task 2. The song will be played on an electronic
            organ prior to the start of Task 2. Accuracy can be defined
            as a note that deviates less than a half note from the
            prescribed tone. The judges' decisions are final.

        2.  10 points if the first ten notes are audible and generally
            in tune to the song picked by the contestant, or

        3.  5 points if some of the first ten notes are out of tune, or

        4.  0 points if most of the first ten notes are out of tune.

    iii. Meter of the notes (10 points maximum)

         1.  10 points if the pattern of the notes follows the song in
             proper meter, or

         2.  5 points if only some of the song follows the proper meter,
             or

         3.  0 points if most of the song fails to follow the proper
             meter.

    iv. Bonus points for the song (15 points maximum)

        1.  A graduated range of points from 0 to 15 depending on
            whether or not the chosen song shows any added features
            worthy of bonus points. Added features could include adding
            half tones (sharps or flats), creating chords (simultaneous
            note playing), playing much more than just the first ten
            notes, utilizing complex patterns or meter, producing loud
            tones, adding percussion instruments, etc.

CONTEST PROCEDURE

9)  The order in which teams will participate is selected by a random
    process. Each contestant will be given a location (in Area 1, Area
    2, or Area 3). The contestant and his/her team will be given an
    eight-minute period of time to set-up, complete Task 1 and Task 2,
    and remove the device from the contest site. Strict time limits will
    be imposed to ensure that all contestants are able to operate their
    device. You will be asked if you choose to use a wireless microphone
    to help amplify the sounds that your device creates. Be aware that
    using a microphone may result in an award of fewer points for that
    category (8.c.ii). You are allowed to position and secure the
    microphone on the device, but no human is allowed to hold the
    microphone.

> The official starter will give a countdown (3....2....1....GO!) for
> the start of operation for Task 1. Timers will start the time at the
> starter's direction. The timers will stop the watch at the direction
> of the official starter. The official starter will voice an audible
> "STOP!" when the C Major scale has been completed. Once Task 1 has
> been completed, the contestant is allowed to reset the device and get
> ready for Task 2.
>
> The sheet music handed to the judges will be played on an electric
> organ prior to the beginning of Task 2 to acquaint the judges with the
> chosen song. The official starter will give a countdown
> (3....2....1....GO!) for the start of operation for Task 2. Timers
> will start the time at the starter's direction. The timers will stop
> the watch at the direction of the official starter. The official
> starter will voice an audible "STOP!" when the first ten notes of the
> song have been completed. The contestant is allowed to let the device
> continue to play the remainder of the song and may terminate the
> device at any time prior to the 60 second time limit. Once Task 2 has
> been completed the contestant will then be asked to quickly remove
> their device from the contest site and place their entry in an area
> designated by contest officials for further judging.

OFFICIAL SCORING

10) The time will be averaged by two or more official timers. Only if
    the time limits are out of the prescribed range (Task 1 between 5
    and 15 seconds; Task 2 between 5 and 20 seconds (first ten notes
    only)) is the time recorded. If the time limit is out of the
    prescribed range, then no additional points can be awarded for that
    task. The team of judges will agree on all of the scoring, record
    the values, total the points, and hand the results to the field
    judge.

AWARDS

11) Trophies will be divided into two categories: JPL
    employees/family/contractor entries and school team entries.
    Trophies for highest point total will be given for first, second,
    and third place for each category at all contests (regional contests
    and the JPL contest). In case of a tie, equal trophies will be
    awarded. Certificates will be issued for the lightest, heaviest,
    smallest, largest, most unusual, most artistic, most creative, and
    loudest designs.

JPL EMPLOYEE, CONTRACTOR OR FAMILY MEMBER ENTRY FORM FOR 2007 INVENTION
CHALLENGE

> ENTRY NUMBER \_\_\_\_\_

Date Received: \_\_\_\_\_\_\_\_ Time received: \_\_\_\_\_\_\_\_\_

Name(s):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

M/S: \_\_\_\_\_\_\_\_\_\_\_\_

Phone: [(\_\_\_\_)\_\_\_]{.underline}\_\_\_\_\_\_\_\_\_\_

E-mail Address: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title of Entry (be creative):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Put entry number somewhere on the device** **(6 inches or larger in
height)**

JPL Team:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ENTRY
NUMBER \_\_\_\_\_\_

= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

FOR OFFICIAL USE ONLY

Weight: \_\_\_\_\_\_\_ pounds

Length: \_\_\_\_\_ inches, Width: \_\_\_\_\_inches, and Height:
\_\_\_\_\_inches

Time for Task 1 operation: \_\_\_\_\_\_\_\_\_\_ seconds

Time for Task 2 operation: \_\_\_\_\_\_\_\_\_\_ seconds

**[Judges' Scores]{.underline}**

Appearance points (0 to 10): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Creativity points (0 to 15): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Task 1 Points.....

Loudness of notes (15 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Accuracy of notes (15 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Quality of notes (10 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Task 2 Points.....

Intonation of song (10 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Meter of song (10 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_

Bonus points for song (15 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_

**Point Total for all Categories = \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

# 

Comments:

SCHOOL ENTRY FORM FOR JPL 2007 INVENTION CHALLENGE

> ENTRY NUMBER \_\_\_\_\_

Date Received: \_\_\_\_\_\_\_\_ Time received: \_\_\_\_\_\_\_\_\_

School Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Single Point of Contact Information:

Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone: [\_(\_\_\_\_)\_\_]{.underline}\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Email Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

School
Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Street City Zip Code

Team Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Entry Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Put entry number somewhere on the device (6 inches or larger in height) 

Team Member Names and Ages (if over 18, state Citizenship):

1)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Chaperone/Teacher Names and Citizenship (mandatory)

1)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Note: All persons planning to attend the JPL contest must fill out and
turn in an "Authorization and Release for Photos and/or Video Recording
Photography Release Form". Students under 18 years of age must also have
their parent or guardian sign the form.**

Teacher/Educator Advisor:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Phone of Advisor: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SCHOOL NAME \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ENTRY NUMBER \_\_\_\_\_\_

= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

FOR OFFICIAL USE ONLY

Weight: \_\_\_\_\_\_\_ pounds

Length: \_\_\_\_\_ inches, Width: \_\_\_\_\_inches, and Height:
\_\_\_\_\_inches

Time for Task 1 operation: \_\_\_\_\_\_\_\_\_\_ seconds

Time for Task 2 operation: \_\_\_\_\_\_\_\_\_\_ seconds

**[Judges' Scores]{.underline}**

Appearance points (0 to 10): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Creativity points (0 to 15): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Task 1 Points.....

Loudness of notes (15 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Accuracy of notes (15 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Quality of notes (10 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Task 2 Points.....

Intonation of song (10 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Meter of song (10 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_

Bonus points for song (15 point max): \_\_\_\_\_\_\_\_\_\_\_\_\_

**Point Total for all Categories = \_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Comments:

**Jet Propulsion Laboratory**

California Institute of Technology

4800 Oak Grove Drive

![](media/image1.wmf){width="1.1597222222222223in"
height="0.34791666666666665in"}Pasadena, California 91109-8099

**AUTHORIZATION AND RELEASE**

**FOR PHOTOS AND/OR VIDEO RECORDING**

SUBJECT PRODUCTION: **2007 JPL Invention Challenge**

I,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
hereby grant to the California Institute of

(Person signing form)

Technology the right, without fee, to make and use photos and/or video
tape recordings

of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_in
connection with the subject

(Person attending production)

production in any manner or form and for any lawful purpose at any time.
I waive any right that I may have to review or approve the finished
product, or the use to which it may be applied. I release and discharge
the California Institute of Technology and its employees, and its
subcontractor(s) and employees from any liability to me by virtue of any
representation that may occur in the making or editing of said photos
and/or video tape recordings.

I have read this agreement before signing below and warrant that I fully
understand its contents.

> Signed:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Parent or
> Guardian:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Date:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> (if not of legal age)

School Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Entry \# \_\_\_\_\_\_\_\_

(leave blank)