Your First Name:    Your Last Name:

Please select your current grade in school: 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade College Level/Adult    School Name:

Your Home Address:

City:   State: Select One: Texas Louisiana   Your Zip Code:

Daytime Phone Number (including area code):    Email:

Have you ever lived in Japan?  If so, for how long?

Have you ever studied on a study-abroad program ? If so , for how long ? 
From: To:

Have you attended school in Japan, what age were you when you started?:

Did you ever participate in a Japanese Language Speech Contest before?  If so, where? Please Select One: San Antonio, TX Austin, TX Dallas, TX Houston, TX Other  

Please select the division that you will be participating in: Please Select One: Division 1: Poetry Division 2: Poetry Division 3: Free Speech Division 4: Free Speech Division 5: Free Speech

PARENT OR GUARDIAN - PLEASE READ

By checking the box (below), you are giving your son/daughter permission to participate in the 22nd annual Japanese State Language Speech Contest which will be held on March 5th, 2011.   I hereby release his/her Japanese teacher, his/her school and all parties of sponsors for the March 5th, 2011 Speech Contest from any liabilities (should any incidents occur during the contest).

By checking this box, you are agreeing to the terms and conditions of the information above.