Queer Science 2022 Registration Form
**Registration for the event has closed as of May 28th. New submissions will not be registered for the June 11th event.**

This is the registration form for the Queer Science conference taking place on Saturday, June 11th, 2022.

The UConn Vergnano Institute for Inclusion is excited to offer a full day of STEM-related presentations and demos, curated by LGBTQIA+ researchers at UConn. LGBTQIA+ youth deserve to see themselves as successful scientists and engineers across disciplines, especially in today's political climate.

More event information is available on our website: https://inclusion.engr.uconn.edu/queer-science-2/ 

Any individual high school-aged student in the state of Connecticut who identifies as LGBTQIA+ can fill out this form to register for the Queer Science event. If you are a teacher or GSA leader who plans to bring a large group of students, please contact our event coordinator directly at: anna.marie@uconn.edu 

If you're comfortable, you can also have your parent/guardian fill out and sign our consent and release form for taking photographs and recordings of you during our event. Please send this completed form to anna.marie@uconn.edu. https://inclusion.engr.uconn.edu/wp-content/uploads/2021/05/photo-releaseform.pdf
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First Name *
Last Name *
Chosen Name *
Email Address *
How do you identify within the LGBTQIA+ community?
How do you identify racially/ethnically?
Do you have any allergies? *
What are your dietary restrictions? *
Do you require any accommodations for this event? *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact Email *
Do you wish to have your photo taken at this event? *
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