27th IIEE–CSC R E G I O N A L QUIZ SHOW REGISTRATION
FORM
Official Representatives on the Forthcoming Regional Quiz Show NAME OF SCHOOL
Venue: ____________________________________
Date: _______________
PERSONAL INFORMATION Name: IIEE-CSC Membership No.: Address: Contact No: Birthday/Age:
PERSONAL INFORMATION Name: IIEE-CSC Membership No.: Address: Contact No: Birthday/Age:
PERSONAL INFORMATION Name: IIEE-CSC Membership No.: Address: Contact No: Birthday/Age:
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PERSONAL INFORMATION Name: IIEE-CSC Membership No.: Address: Contact No: Birthday/Age:
PERSONAL INFORMATION Name: IIEE-CSC Membership No.: Address: Contact No: Birthday/Age:
Coach/es: _______________________________ Address: ________________________________ Contact No.: _____________________________
Submitted by:
Noted by:
_______________________
_______________________
School Chapter President
Electrical Engineering
(Signature over printed name)
Department Head (Signature over printed name)
Note: Accomplish this form completely and pls. write legibly.
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