Request edit access
Jack Kilby STEM Day School Sponsor Registration
Jack Kilby STEM Day
November 19, 2018, 8 a.m. - 2 p.m.
Keynote Speaker: Kantis Simmons 'STEM Is Everywhere'
Barton Community College
245 NE 30 Road
Great Bend, KS 67530
Contact us at (620) 792-9200 or JKSTEMDay@bartonccc.edu for more information!
Email address *
Sponsor's First Name *
Your answer
Sponsor's Last Name *
Your answer
Sponsor's School Information
Please help us update our records by providing your school's contact information in the following questions.
Sponsor's School *
Your answer
Sponsor's School Street Address *
Your answer
Sponsor's School City *
Your answer
Sponsor's School Zip Code *
Your answer
Sponsor's School Phone Number *
Your answer
Participants
Please provide the anticipated number of attendees below.
Anticipated Number of Adults Attending *
Please include yourself here.
Your answer
Anticipated Number of Students Attending *
Number of students you anticipate will register with you as their sponsor.
Your answer
Anticipated Number Attending Sponsor-Only Breakout Session with Kantis Simmons *
Please include yourself if you plan to attend the sponsor-only breakout session with Kantis Simmons.
Your answer
If unable to attend, please contact us at JKSTEMDay@bartonccc.edu.
Thank you for your participation in JKSD 2018!
Charlotte Cates
On behalf of the Jack Kilby Planning Committee
JKSTEMDay@bartonccc.edu
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service