Posters-at-the-Capitol

Abstract Submission Form

Registration Deadline: October 21, 2009

* indicates Required Fields

* Please select your university:
Eastern Kentucky University
Kentucky Community and Technical College System
Which KCTCS campus?
Kentucky State University
Morehead State University
Murray State University
Northern Kentucky University
University of Kentucky
University of Louisiville
Western Kentucky University

* How many student authors will be listed on the Poster?

NOTE: If there are more than 6 student participants, please submit this form with the contact information of 6 students, then submit the form again with contact information for the additional members. List the same Student Contact Person each time.

Please select one student to serve as the Student Contact Person. This individual will be responsible for contacting and sharing information with the group members. List contact information for additional participating members at the bottom of the form.

Student Contact Person:
* Student Name Mr. Ms.
* Grade Level Freshman Sophomore Junior Senior
* Department

Current Mailing Address
* Address
* City
* State
* Zip Code
* Telelephone  Number
* E-Mail Address
* Home County
(the county in which you are registered to vote)
* KY House District #
* KY Senate District #
Sponsor/Mentor's Contact Information:
* How many faculty sponsors/mentors will be listed on the poster?
If more than one sponsor will be listed, please enter the Contact Information for one sponsor below. Provide information for other sponsors at the bottom of the form.
* Name
* Department
* Address
* City
* Zip Code
* Telephone Number
* E-Mail Address

* Abstract Title

* Abstract / Summary or Description of Work (Limit 250 words):

If accepted to participate in Posters-at-the-Capitol, do you consent to having your e-mail address printed in the program booklet?

(Providing this means of contact in the program booklet may be beneficial to your networking with other student participants, legislators, and others following the event. However, you should understand that your acceptance to participate does not depend on consenting.)		 Yes No
Student Participant #2
Student Name Mr. Ms.
Grade Level Freshman Sophomore Junior Senior
Department

Current Mailing Address
Address
City
State
Zip Code
Telelephone  Number
E-Mail Address
Home County
(the county in which you are registered to vote)
KY House District #
KY Senate District #
Student Participant #3
Student Name Mr.  Ms. 
Grade Level Freshman Sophomore Junior Senior
Department

Current Mailing Address
Address
City
State
Zip Code
Telelephone  Number
E-Mail Address
Home County
(the county in which you are registered to vote)
KY House District #
KY Senate District #
Student Participant #4
Student Name Mr. Ms.
Grade Level Freshman Sophomore Junior Senior
Department

Current Mailing Address
Address
City
State
Zip Code
Telelephone  Number
E-Mail Address
Home County
(the county in which you are registered to vote)
KY House District #
KY Senate District #
Student Participant #5
Student Name Mr.  Ms.
Grade Level Freshman Sophomore Junior Senior
Department

Current Mailing Address

Address
City
State
Zip Code
Telelephone Number
E-Mail Address
Home County
(the county in which you are registered to vote)
KY House District #
KY Senate District #
Student Participant #6
Student Name Mr. Ms.
Grade Level Freshman Sophomore Junior Senior
Department

Current Mailing Address
Address
City
State
Zip Code
Telelephone  Number
E-Mail Address
Home County
(the county in which you are registered to vote)
KY House District #
KY Senate District #
Faculty Sponsor/Mentor #2
Name
Department
Address
City
Zip Code
Telephone Number
E-Mail Address
Faculty Sponsor/Mentor #3
Name
Department
Address
City
Zip Code
Telephone Number
E-Mail Address
Faculty Sponsor/Mentor #4
Name
Department
Address
City
Zip Code
Telephone Number
E-Mail Address

Thank you for submitting a project to Posters-at-the-Capitol. To verify that your submission has been received, we will contact you via email (at the address you have provided above) within three working days.

IF YOU DO NOT RECEIVE THIS VERIFICATION EMAIL, PLEASE CONTACT US AT (270) 809-3192 or by email at jody.cofer@murraystate.edu. Again, we appreciate your support and interest in Posters-at-the-Capitol.

FOR YOUR RECORDS, PLEASE PRINT A HARD COPY OF THIS FORM AND BE CERTAIN TO SAVE A COMPLETE COPY OF YOUR ABSTRACT, SUMMARY OR DESCRIPTION OF YOUR WORK.

Validation
Before pressing Submit, you MUST enter the keyword "Research" in the following textbox.
* Keyword: