STEM Summit Registration

2018 Maine STEM Summit Registration

“Looking Ahead: Defining and Advocating for STEM”

November 16, 2018
Central Maine Community College (Auburn, Maine)

Cost: $15

Please fill out the form below to register for the STEM Summit on November 16th, 2018. If paying by credit card or Paypal please select "Paypal." If paying by check please select "Pay Offline," make payable to “MMSA” and mail to: Maine Mathematics & Science Alliance 219 Capitol Street Suite 3 Augusta, ME 04330 ATTN: STEM Summit 2018
RM_Stats
I am registering as a
Participant

Speaker

Type of Registration
Business & Industry

K-12 Teacher/Administrator

Higher Educator

Organization/Research

Policy Makers Government

K-16 Student Volunteer

Other

First Name (as you would like it to appear on name tag)^*
Last Name (as you would like it to appear on name tag)^*
Title or Position
Institution or Organization
Address

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Phone Number
Email
Special Dietary Restrictions: We will attempt to accommodate those with special dietary needs
Photo Release^*
Video footage and photographs will be taken throughout the day for purposes such as education, newsworthy, demonstration, or other general public information.
Additional Comments: Is there anything we have forgotten
How did you hear about this event?
mainestem.org

STEM Collaborative Partner Organization

List Serv

Social Media

Other

Payment Method
PO# (if applicable)
Registration: $15
STEM Summit Donation *Optional*
Select a payment method^*

Pay Offline