Title:
First Name:
Last Name:
Age:
Male
Female
Birth Date:
E-mail:
Home Address:
City:
State:
Zip:
Home Telephone:
Cell Telephone:
Parents' Names:
Office Telephone:
Present Year in School:
Approximate School Grade Average:
School Name:
School Address:
City:
State:
Zip:
Name and Department of high school teacher
closest to your seminar subject:
Title:
First Name:
Last Name:
Department:
Your Member of Congress (U.S. House of
Representatives):
(Look it up: www.house.gov)
Where do you wish to receive further information?
|
