Judge’s Name: ________________________________________________

Address: ________________________________________________

City and Zip: ________________________________________________

Phone Number: ________________________________________________

E-mail Address: ________________________________________________

Geographic area to which you will travel: ____________________________

________________________________________________

________________________________________________

Preferred time of day: ____________________________________________

If you have a contact with an area High School that would be interested in the program, please let us know and we will contact them:

High School: _______________________________________________

Address: _______________________________________________

City and Zip: _______________________________________________

Contact Person: _______________________________________________

Phone Number: _______________________________________________