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First Name*

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Are you applying as an individual or as a team?*
---IndividualTeam If team, there are ---12345678910 members in my team, including me.

If team, write full names, schools, and grades of all team members.

Country / Location of Residency*
---AfganistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia & HerzegovinaBotswanaBrazilBritish Indian Ocean TerBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCayman IslandsCentral African RepublicChadChannel IslandsChileChinaChristmas IslandCocos IslandColombiaComorosCongoCook IslandsCosta RicaCote DIvoireCroatiaCubaCuracoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerGabonGambiaGeorgiaGermanyGhanaGibraltarGreat BritainGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuyanaHaitiHawaiiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SoutKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalaysiaMalawiMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMidway IslandsMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNambiaNauruNepalNetherland AntillesNetherlandsNevisNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalau IslandPalestinePanamaPapua New GuineaParaguayPeruPhillipinesPitcairn IslandPolandPortugalPuerto RicoQatarRepublic of MontenegroRepublic of SerbiaReunionRomaniaRussiaRwandaSt BarthelemySt EustatiusSt HelenaSt Kitts-NevisSt LuciaSt MaartenSt Pierre & MiquelonSt Vincent & GrenadinesSaipanSamoaSamoa AmericanSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTahitiTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IsTuvaluUgandaUkraineUnited Arab ErimatesUnited KingdomUnited States of AmericaUraguayUzbekistanVanuatuVatican City StateVenezuelaVietnamVirgin Islands (Brit)Virgin Islands (USA)Wake IslandWallis & Futana IsYemenZaireZambiaZimbabwe

Full Home Address*

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Date of Birth*
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Grade*
---456789101112

Full School Name*

Your E-mail*

Your Phone (Mobile number, with area code)*

Title of Your Work*

Short Explanation of Your Work (1,000 words maximum)*

Link to Your YouTube Video*

Picture of You (for individual) or Your Team (for team) (Maximum size is 10MB)*

By checking this box*, (my team members and) I hereby 1) agree to participate in International Imagiscience Science Competition, 2) agree that I/we have read and accept the rules and guidelines, 4) consent for my/our voice(s) and/or image(s) to be included in the entry, 3) consent to grant Imagiscience permission use my/our entry an unlimited number of times in perpetuity in any and all of its publications and media in connection with the Imagiscience Science Competition or other National Imagiscience purposes, and 4) consent to reveal my/our name(s) and identity(ies) in descriptive texts and/or commentaries. If under 18 years of age, please provide an electronic signature of all members' custodial parents for agreement and consent (Type name(s) below).

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