Please completely fill out the form below and click submit. You should receive a receipt within two weeks after submission. If you do not receive this, please resubmit this form or call 716-885-3951. The selection committee will contact you to discuss details of this program, before the selection process proceeds.

Your Name (required)

School Name (required)

Your Email (required)

Your Phone Number

I am interested in becoming a minor at the following APS meeting:

Explain your interest:

I am declining to become a Miner, but I am recommending the Foundation contact:


School Name


Phone Number