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Women in STEM Presenter Registration
October 30, 2019 Bowen Thompson Student Union, BGSU
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Email
*
Your email
First Name
*
Note: Your name will appear on your name tag exactly as you enter it here.
Your answer
Last Name
*
Note: Your name will appear on your name tag exactly as you enter it here.
Your answer
Organization Name
*
Please enter the name of your Company, School, or Organization
Your answer
Work Phone
Your answer
Work Address
*
Your answer
Work City
*
Your answer
Work State
*
Your answer
Work Zip Code
*
Your answer
Current Status
*
Please identify your current status based on the options available.
College / University Faculty or Staff
PreK-12 Teacher (or Retired Teacher)
Undergraduate Student
Graduate Student
Informal Educator
For-Profit Education Organization Staff
Community Business or Organization Representative
Other:
Occupation
Your answer
Co-Presenters
*
I have one or more co-presenters
Yes
No
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