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Conference Registration

*First Name *Last Name
*Organization *Title
Collaborative name (if applicable)
Collaborative role (if applicable)
*Event Participant Type(s)
Attendee Collaborative Lead Exhibitor NGCP Staff
National Champions Board Member Presenter Sponsor
Website
*Work Address
*City *State *Zip Code (xxxxx)
Work Phone Cell Phone
*At least one phone number is required, formatted xxx-xxx-xxxx.
*E-Mail Address
(Your e-mail address is required for registration confirmation
and updates; however, NGCP does not release or sell e-mail
addresses to outside entities.)
*Is your organization registered in the NGCP Program Directory?
Yes No Not Sure
Professional development session selection (Thursday 1-3:30 PM)
Select your three choices
Session Title First choice Second choice Third choice
Building Inquiry Science Capacity in Youth Programs
Engineering is Elementary
Equal Access to Science: Universal Design and Strategies for Including All Learners
Inspire a Future Engineer! Strategies to Integrate Career Exploration in your STEM Curriculum
Ten Methods for Inspiring Girls' Interest in the T and E of STEM!
Outreach 4 Change: Increasing the Gender & Racial/Cultural Diversity of Young People Pursuing Engineering
*Indicate the meals you will attend:
4/25 evening reception 4/26 breakfast 4/26 lunch 4/27 breakfast 4/27 lunch
Dietary Restrictions:
I require special accommodations in order to fully participate in this event.
Please explain:
(A conference representative will contact you to review your specific needs.)
*My goals for attending this event...
Photo Authorization
Photographs will be taken throughout the event for use in future National Girls Collaborative Project (NGCP) publications, websites, or communications for purposes of promoting the NGCP and its mission. By submitting this registration you are granting full permission to the NGCP to use a photo which might include you as a participant. Participant names will not be linked to photos in any publication without prior permission. If you DO NOT wish to grant authorization for this, please check the box below and email a photo to sbredin@edlabgroup.org prior to the event. This photo will be used to identify you in event photos, which will not then be used.
DENIED photo authorization
*How did you find out about this event
AAUW Colleague Email invitation from NGCP Facebook
Local Collaborative Communication NGCP Newsletter Twitter Other
Additional Participation Opportunities
I would like an NGCP staff member to contact me about:
Exhibiting at the Conference Volunteering at the U.S.A. Science and Engineering Festival April 27-29
To complete your registration, enter an exemption code or credit card information below.
Exemption Code (if applicable):
*Card Type *Card Number *CVV2 *Month *Year
/
By clicking the 'Submit Payment' button I authorize $375 to be charged to my credit card.
Cancellation/Substitution Policy
Conference registration cancellations will be accepted in writing through March 23, 2012. Registration cancellations will be subject to a $95 service fee. After the cancellation deadline, no refunds will be granted. If you are unable to attend, you may substitute another individual in your place at no extra charge until April 15. All cancellations must be submitted in writing to sbredin@edlabgroup.com.
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