Quantum Registration - Science Math Resource Center

Last Name

First Name

Phone Number

Which of the following best describes your professional role?

Business/Industry alliance

K-12 education

Youth outreach

Public outreach

State/local government

Higher Education

Other

Name of your organization

Are you interested in hosting a booth or table to present your work (at no cost)?

Yes

Maybe

Are you interested in hosting a small group discussion through "working groups" in the afternoon?

Yes

Maybe

Will you need travel reimbursement (mileage, lodging, per diem)? If you answer yes, a member of the planning committee will reach out to you.

Yes

Will you require a stipend for participation? If you answer yes, a member of the planning committee will reach out to you.

Yes

Quantum State Convening