Latinas in STEM Membership Form
Latinas in STEM seeks to grow its membership with Latina students and professionals that are committed to achieving the Latinas in STEM Mission & Purpose.
Birthdate
MM
/
DD
/
YYYY
Full Name *
First, M., Last
Your answer
Email *
Your answer
Please select your geographical region *
Phone Number *
XXX-XXX-XXXX
Your answer
City & State *
(current residence)
Your answer
Professional or College Member *
Do you speak Spanish?
List All Degrees with Major
Please indicate associated degree (e.g., Mechanical Engineering - BS)
Your answer
College(s)
Your answer
Current Employer
Company Name & City, State
Your answer
Job Industry
Your answer
Your Twitter Handle
Your answer
What do you expect to get out of your membership? Why are you joining?
Your answer
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