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THEODORE ROOSEVELT PUBLIC SPEAKING CONTEST ENTRY FORM Name and Address of High School________________________________________________ _____________________________________________________________________________ School Telephone Number ______________________________________________________ Name of Contestant ___________________________________________________________ Contestant's Address _________________________________________________________ ____________________________________________________________________________ Contestant's Phone Number ____________________________________________________ Contestant's E-Mail ___________________________________________________________ Contestant's Grade (Circle) 9 10 11 12 Teacher/Coach Name_________________________________________________________ Title _______________________________________________________________________ Teacher/Coach Telephone _____________________________________________________ Teacher/Coach E-Mail ________________________________________________________ Principal/ Headmaster ________________________________________________________ Supervising Chairperson _______________________________Dept.___________________ Please return this form on or before Friday, February 6, 2009 to: Mark Lozo Theodore Roosevelt Inaugural National Historic Site 641 Delaware Avenue Buffalo, NY 14202
Home school students may contact the Theodore Roosevelt Inaugural Siteif they have questions regarding filling out this form. |
Last updated: February 26, 2015