Contact Information:

First Name: Last Name:

Phone: - -

email:

High school students only:
What is your area of interest?

Demographics

Gender:   Male Female

Ethnicity (you are able to select more than one by pressing CTRL-click (or Cmd-Click on Mac)):

White/Non-Hispanic African/Black American Native American Hispanic Latin-American Asian American (Far East, S. E. Asia, Indian Subcontinent) Pacific Islander Other I do not wish to provide this information

If Other, please specify:

SACNAS Affiliation

Are you affiliated with a SACNAS chapter? YES NO
If yes,

What's the name of the chapter:

If no:

Are you a national SACNAS member? YES NO

If you are a current member of SACNAS please indicate your SACNAS ID number:

Special Requests

Do you require any special needs that require accommodations? Please be specific.

Do you require special meals? Please indicate if you are vegetarian, vegan or have food allergies. Please be specific.

Is there anything else we should know about.
If so please add it below.

Survey for Planning Purposes

Please answer the following questions to assist in the planning process.

Will you need to park on the Auraria campus? YES NO

What is your t-shirt size? (T-shirts will be sold at the meeting for $5.00 each)
Small Medium Large X Large 2X Large

Photograph Release: SACNAS publishes information about the education programs and resources on the web, in CD-ROM and in print version. Selected group and individual photographs of SACNAS events will be included.

I hereby grant SACNAS authorization to publish my photograph(s) on the web, on CD-ROM, and in print version. I understand that these published materials contain information intended for distribution in science and science education environments, such as workshops and science conferences and meetings, as well as other related means and events.

Yes No

Registration Fees

Payment made out to: CSU-SACNAS