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Exploring Human Anatomy 2023: Pre-Registration Form
Saturday, July 15th, 2023
1:00-4:00pm
Kentucky Center for African American Heritage
Contact us at
info@wlmsp.org
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
Your answer
Answer the following questions for yourself, the person completing this form.
Grade
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Undergraduate
Trade School
Graduate
Life
Clear selection
Age
Your answer
Do you like science?
*
Yes
No
How did you hear about this event?
Radio
Word of Mouth
Flyer
Flyer from school
Flyer from daycare
Event
Other
Do you utilize social media?
Facebook
Instagram
Twitter
Snapchat
Other
Are you a participant or volunteer?
*
Participant
Volunteer
If volunteering, in what capacity would you like to share?
Presenter: Medical Professional
Activity leader
Host/Hostess
Registration tables
Set-up
Lunch preparation
Break-down
Door to door canvassing/passing out flyers
Zip Code
*
Your answer
Does your family have access to the internet via a computer/tablet?
Yes
No
Clear selection
How many people, other than you, will be attending?
*
Just me
1
2
3
4+
If others are attending with you, then what are their ages?
Your answer
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