KSEA NMSC 2023 & Physics Registration - Idaho

KSEA NMSC 2023 & Physics Registration

Idaho
Student Name*

First NameLast Name
Student Birth Date

MonthDayYear
School Name
School Level*

4th grade5th grade6th grade7th grade8th grade9th grade10th grade11th grade
Student Email (Do not use Parent's email address here)*
example@example.com
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please choose Chapter*

Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian email/(KSEA registered email). Sign up KSEA member at: https://www.ksea.org/signUp*
example@example.com
Relationship (e.g., son, daughter)

Please select the exam that you want (You can get discount code if your chapter offers it. Please contact your local chapter president or KSEA ITM at itm@ksea.org).

Math

$35.00

Physics

$ Free

Donation

$5.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details (If your total is $0.00, please do not enter the credit card information)
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty: