2018 Maryland Collegiate STEM Conference Registration (April 14th at Howard Community College)
After completing this form, please submit payment in the form of a check written out to "Carroll Community College" and please make sure to write "Maryland Collegiate STEM Conference" and send it to Dr. Raza Khan, Division Chair of Sciences, Carroll Community College; 1601 Washington Road, Westminster, MD 21157. If the name and the address on the check is not of the registrant, please indicate that with a paper attached to the check. Credit cards will also be accepted. For information on completing a transaction, please see the Conference Registration Information website: http://mcsc.website/registration.html
What is your first name? *
Your answer
What is your last name? *
Your answer
What name would you prefer on your name tag? *
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If you are given one, what is your school email address? Please type none if you do not have one. *
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If there is another personal email address (gmail, yahoo, etc.) you would like to provide, please do so here:
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What is your preferred mailing address (may be home or business)? *
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What is your phone number? XXX-XXX-XXXX *
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What college / school are you affiliated with? *
Your answer
What is your college / school address? (Street; Department; Building and Office; City; State; Zip) *
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What is your college / school phone number?
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What is your role at that college / school? You may check more than one. *
Required
Have you or will you be submitting a presentation or poster? *
What is your registration type? *
How will you be paying? *
Do you have dietary restrictions? *
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If you answered "Other" to the dietary restrictions question above, please indicate those other restrictions here.
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Thank you for registering for the 2018 Maryland Collegiate STEM Conference. We look forward to seeing you at Howard Community College on April 14th.
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