Your Information:

Your First Name:    Your Last Name:

Please select your current grade in school: Please select here: 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade    School Name:

Please provide the first and last name of your language teacher:

Your Home Address:

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

Daytime Phone Number (including area code):    Email:

Previous Speech Contest Participation:

Did you ever participate in a Japanese Language Speech Contest?  If so, where? Please Select One: San Antonio, TX Austin, TX Dallas, TX Houston, TX Other   Please note:  All Contestants, with the exception of Division 1, are not allowed to repeatedly compete in the same division.

What was the most recent division that you competed in? Please Select One: Division 1 Division 2 Division 3 Division 4 Division 5 I've never competed in a speech contest

If you did participate in a recent speech contest, did you place 1st, 2nd or 3rd?  Please Select One: First place Second place Third place

If your level of competition involves 'free speech', what is the title of your speech?  

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

Division Three Contestants:

Division Three Contestants must provide a summary of their Free Speech (please provide the summary in 75 words or less:

Division Four and Five Contestants:

Division Four and Five Contestants must provide a summary of their Free Speech (please provide the summary in 75 words or less and in Japanese (200 words or less):

Please provide your Free Speech in English (75 words or less) here:

Please provide your Free Speech in Japanese (200 words or less) here:

Reception Information:

There will be a reception, immediately following the contest.  It will be held at the official residence of the Consul General of Japan at Houston.  Will you attend the reception? Please Select One: Yes, I will attend the reception. No, I will not attend the reception.

If you are planning to attend, how many will be attending in your party? Please select one: I will be attending (one person) Two will be attending (myself and one person) Three will be attending (myself and two people) Four will be attending (myself and three people)

Please provide the names of people who will be attending the reception in your party:               

PARENT OR GUARDIAN - PLEASE READ

By checking the box (below), you are giving your son/daughter permission to participate in the 20th annual Japanese Language Speech Contest which will be held on March 6th, 2010.   I hereby release his/her Japanese teacher, his/her school and all parties of sponsors for the March 6th, 2010 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.