Section 1 of 1
2021 STEM Night - Attendee Registration
Thank you for registering for the virtual 2021 STEM Night on May 1st from 5:30 - 8 pm EST. Students will be able to learn all about STEM careers, watch live demos, and participate in interactive activities. Please feel free to reach out with any questions at katec15@icloud.com or vbogdanski@southingtonschools.org.
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Student's Gender Identity
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How many KIDS will be attending the STEM Night?
How many KIDS will be attending the STEM Night?
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How many PARENTS will be attending the STEM Night?
How many PARENTS will be attending the STEM Night?
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Where did you hear about our STEM Night event?
Where did you hear about our STEM Night event?
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Instagram
Facebook
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Elementary School
From a friend
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If you selected "Other," from whom/where?
If you selected "Other," from whom/where?
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Please indicate how you identify yourself below. You may select more than one option
Please indicate how you identify yourself below. You may select more than one option
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State, please select "International" if you do not live in the United States
State, please select "International" if you do not live in the United States
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1.
Alabama
2.
Alaska
3.
Arizona
4.
Arkansas
5.
California
6.
Colorado
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Connecticut
8.
Delaware
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Florida
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Georgia
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Hawaii
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Idaho
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Illinois
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Indiana
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Iowa
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Kansas
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Kentucky
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Louisiana
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Maine
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Maryland
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Massachusetts
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Michigan
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Minnesota
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Mississippi
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Missouri
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Montana
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Nebraska
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Option 28
29.
New Jersey
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New Mexico
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New York
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North Carolina
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North Dakota
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Ohio
35.
Oklahoma
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Oregon
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Pennsylvania
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Rhode Island
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South Carolina
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South Dakota
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Tennessee
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Texas
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Utah
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Vermont
45.
Virginia
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Washington
47.
West Virginia
48.
Wisconsin
49.
Wyoming
50.
International
51.
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If you selected "International" above, please indicate which country you currently live in below.
If you selected "International" above, please indicate which country you currently live in below.
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1.
Afghanistan
2.
Albania
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Algeria
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Andorra
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Angola
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Antigua and Barbuda
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Argentina
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Armenia
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Australia
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Austria
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Azerbaijan
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The Bahamas
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Bahrain
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Bangladesh
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Barbados
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Belarus
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Belgium
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Belize
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Benin
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Bhutan
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Bolivia
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Bosnia and Herzegovina
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Botswana
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Brazil
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Brunei
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Bulgaria
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Burkina Faso
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Burundi
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Cabo Verde
30.
Cambodia
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Cameroon
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Canada
33.
Central African Republic
34.
Chad
35.
Chile
36.
China
37.
Colombia
38.
Comoros
39.
Congo, Democratic Republic of the
40.
Congo, Republic of the
41.
Costa Rica
42.
Côte d’Ivoire
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Croatia
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Cuba
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Cyprus
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Czech Republic
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Denmark
48.
Djibouti
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Dominica
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Dominican Republic
51.
East Timor (Timor-Leste)
52.
Ecuador
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Egypt
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El Salvador
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Equatorial Guinea
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Eritrea
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Estonia
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Eswatini
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Ethiopia
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Fiji
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Finland
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France
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Gabon
64.
The Gambia
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Georgia
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Germany
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Ghana
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Greece
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Grenada
70.
Guatemala
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Guinea
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Guinea-Bissau
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Guyana
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Haiti
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Honduras
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Hungary
77.
Iceland
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India
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Indonesia
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Iran
81.
Iraq
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Ireland
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Israel
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Italy
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Jamaica
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Japan
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Jordan
88.
Kazakhstan
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Kenya
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Kiribati
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Korea, North
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Korea, South
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Kosovo
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Kuwait
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Kyrgyzstan
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Laos
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Latvia
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Lebanon
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Lesotho
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Liberia
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Libya
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Liechtenstein
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Lithuania
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Luxembourg
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Madagascar
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Malawi
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Malaysia
108.
Maldives
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Mali
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Malta
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Marshall Islands
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Mauritania
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Mauritius
114.
Mexico
115.
Micronesia, Federated States of
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Moldova
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Monaco
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Mongolia
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Montenegro
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Morocco
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Mozambique
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Myanmar (Burma)
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Namibia
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Nauru
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Nepal
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Netherlands
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New Zealand
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Nicaragua
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Niger
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Nigeria
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North Macedonia
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Norway
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Oman
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Pakistan
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Palau
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Panama
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Papua New Guinea
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Paraguay
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Peru
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Philippines
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Poland
142.
Portugal
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Qatar
144.
Romania
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Russia
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Rwanda
147.
Saint Kitts and Nevis
148.
Saint Lucia
149.
Saint Vincent and the Grenadines
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Samoa
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San Marino
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Sao Tome and Principe
153.
Saudi Arabia
154.
Senegal
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Serbia
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Seychelles
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Sierra Leone
158.
Singapore
159.
Slovakia
160.
Slovenia
161.
Solomon Islands
162.
Somalia
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South Africa
164.
Spain
165.
Sri Lanka
166.
Sudan
167.
Sudan, South
168.
Suriname
169.
Sweden
170.
Switzerland
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Syria
172.
Taiwan
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Tajikistan
174.
Tanzania
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Thailand
176.
Togo
177.
Tonga
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Trinidad and Tobago
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Tunisia
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Turkey
181.
Turkmenistan
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Tuvalu
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Uganda
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Ukraine
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United Arab Emirates
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United Kingdom
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United States
188.
Uruguay
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Uzbekistan
190.
Vanuatu
191.
Vatican City
192.
Venezuela
193.
Vietnam
194.
Yemen
195.
Zambia
196.
Zimbabwe
197.
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If yes, what email?
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I hereby grant STEM Without Boundaries permission to use my photograph/video images in any and all publication for STEM Without Boundaries, including, but not limited to, web site entries and official STEM Without Boundaries social network accounts, without payment or any other consideration in perpetuity. I hereby authorize STEM Without Boundaries to edit, alter, copy, exhibit, publish or distribute all images. I waive the right to inspect or approve the finished product, including written or electronic copy wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photographs or videos.
I hereby grant STEM Without Boundaries permission to use my photograph/video images in any and all publication for STEM Without Boundaries, including, but not limited to, web site entries and official STEM Without Boundaries social network accounts, without payment or any other consideration in perpetuity. I hereby authorize STEM Without Boundaries to edit, alter, copy, exhibit, publish or distribute all images. I waive the right to inspect or approve the finished product, including written or electronic copy wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photographs or videos.
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Would you be interested in attending more STEM Nights?
Would you be interested in attending more STEM Nights?
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