American Chemical Society Dallas - Fort Worth Section 2014 U.S. National Chemistry Olympiad for the Dallas/Fort-Worth Section of the American Chemical Society Pre-registration Form Preferred testing location for Saturday, March 22, 2014 at 8:30 a.m.: please check one. 1. The University of North Texas: Chemistry Building, Room 109 _______ 2. The University of Texas at Arlington: Baker Hall, Room 114
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School Name, mailing address, and phone number
Teacher name, contact phone number, and Email address
Student Information Student Name (Last, First)
US Citizen (Y/N)
Age (as of 3/5/11)
Phone
Please Email or FAX this completed pre-registration form to Professor Brad Pierce (bspierce@uta.edu); FAX 817.272.3808.