ICK! Registration Form 2015
Date: Sunday, April 19th

Location: ITC (Innovative Technologies Complex) at Binghamton University - new Center of Excellence Building
85 Murray Hill Rd, Vestal, NY 13902

Cost: Register by Monday, April 13th for our early bird special for $15 (pay day of event by cash or check). Any later registration will be $20 (also pay day of event by cash or check). Please make check payable to BU foundation and in memo put Binghamton Biomedical Engineering Society (Binghamton BMES).

**NOTE: DUE TO STRICTER REGULATIONS WITHIN THE ITC/COE THIS YEAR, A PARENT/GUARDIAN MUST STAY WITHIN THE BUILDING FOR THE RESPECTIVE SESSION THAT THEIR CHILD IS ATTENDING (i.e. 9am-1pm for morning or 2pm-6pm for afternoon).

We will have a room for parents/guardians in which to stay that is nearby the stations. There will also be an open house taking place in the ITC Rotunda throughout the duration of the day for any parents interested.

**If you have any questions regarding this form, feel free to contact us at binghamtonbioengineers@gmail.com!
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Session *
Child's Name *
Child's Grade *
Child's School District *
Contact Number *
Contact E-mail *
Any Allergies/Concerns?
Are you comfortable with your child being photographed? *
We use these photographs for social media purposes (we will not release any personal information of your child).
Photograph Release Electronic Signature
If you checked yes to the question above, please write your name here.
Would you like a shirt for your child? *
Price: $12 (Before 4/13) or $15 (After 4/13)
If yes, what size? (Child's Size - S,M,L,XL)
Children will be randomly assigned to groups based on age. Do you have any requests for your child's group?
For example, if you would like siblings to be put in the same group, please specify here
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