STEM Conference Registration 2023

Student Profile

Name*

First Last

Age*

Your Mobile Phone Number*

Your Racial or Ethnic Identity*

What is the name of the school you attend?*

Where is your school located?*

Your Grade*

Do you already have an orange Women of the Dream t-shirt?*

Your T-shirt size*

Do you have any special diet needs?

Please list any special health conditions such as asthma, diabetes, etc. below.

Without looking it up, STEM stands for

Have you ever attended a STEM Conference?*

Check all that apply

Choose the career areas you are most interested in learning about:*

Choose 2

Please enter the name of the parent, guardian or other person who should be contacted in the case of an emergency.

Emergency Contact Name*

First Last

Is your Emergency Contact your:*

Emergency Contact Cell Phone*