19th Annual Japanese language Speech Contest
Entry Form
Last Name ________________________ First Name __________________________
Name in Katakana _______________________________ Grade :_____________
Home Address __________________________________________________________
City _______________________ State __________________ ZIP _______________
Telephone ___________________________
E-mail _____________________________
Division Division I Division II Division III Division IV
(Please circle one)
Division V Division VI Division VII
Have you traveled to Japan before ? Yes No
If yes, please indicate the dates and duration of the stay :
__________________________________________________________________________
If you attend school, please indicate the name of the school and the grade or level
School __________________________________ Grade or Level ____________________
If you are taking Japanese at school, please list your teacher’s name and contact information
Name ______________________________________________________________
Tel : ____________________________ Email :_________________________
Please indicate your agreement with the following statement by signing the line below.
“ I will present my speech in the 19th Annual Japanese Language Speech Contest on Saturday
February 9, 2008. I understand the regulation and time limits specified by Japan-America
Societies of Texas and will abide by the judges’ final decisions.”
_________________________________ Date _____________________________
Applicant’s Signature
__________________________________ Date ______________________________
Parent or guardian’s Signature
(If contestant is under 18 years of age)
Applications must be postmarked, faxed or e-mailed by Wednesday, January 15, 2008.
No exceptions will be Made. Please complete and submit this form to:
Japan-America Society of Houston, 4801 Woodway, Suite 140E, Houston, Texas 77056
Tel: (713)963-0121 Fax : (713)963-8270 e-mail : yoko@jashouston.