X-STEM NOVA Registration 2023

Registrant Contact Information

You will NOT need to provide the individual names of your student attendees.

Please tell us about the person completing this form. I am a:*

Educator coordinating a school field trip
Parent/adult coordinating a family trip or homeschool field trip

Registrant Name (the person completing this form)*

First Last

Registrant Email*

All correspondence relating to this event, including the final confirmation and instructions, will be sent to this email address.

School or Organization Information

Type of School / Attendee:*

School Name**

*Please note - You will check-in at the event under this name. If you are a homeschool family attending with children, please list your family name here (i.e. Jones Family Homeschool). If you are registering a group of students on a field trip, please enter your school name. We will NOT collect individual names for your group attendees.

School or Organization Address*

Street Address Address Line 2 City State ZIP Code

Is your school designated as a Title 1 school?*

Attendee Information

Please note that X-STEM presentations and workshops are geared toward upper middle and high school level audience (grades 6-12). Siblings and students outside of these grades are still welcome to attend, however, we will not offer content targeted for lower or higher grade levels.

How many STUDENT attendees are you registering to attend (NOT including chaperones)?*

How many ADULT individuals are you registering to attend (including chaperones, teachers, and parents)?*

We require one chaperone per ten students.

NAME of main adult chaperone who will attend the event.*

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Email for main adult chaperone who will be the main school contact at X-STEM*

Cell Phone for main adult chaperone who will be the main school contact at X-STEM*

How will your group arrive at X-STEM on Friday, October 20, 2023?*

Grade Level of Attendees

Please tell us HOW MANY of your attendees are in:

Elementary School (Grades 5 and lower)

Middle School (Grades 6-8)

High School (Grades 9-12)

18 and Over

HOW MANY of your attendees identify gender as:

If you are not yet sure, please provide approximate numbers here.

Female

Male

Prefer not to say

HOW MANY of your attendees identify race/ethnicity as:

If you are not yet sure, please provide approximate numbers here.

Asian

Black or African American

Hispanic or Latina/Latino

Native American or Alaskan Native

Native Hawaiian or Other Pacific Islander

White

Other

Prefer not to say

Additional Information

Chaperone to Student Ratio*

We require 1 adult chaperone for every 10 students. It is the responsibility of the chaperone(s) to supervise their students during the event.

I understand that we need to provide adult chaperones for our students and that we are responsible for supervising our students during the event. I will share the Waiver and rules with our student, parent and teacher attendees and am signing below on behalf of our entire group.

AGENDA*

X-STEM NOVA will take place from 9:30am to 2:00pm.

9:00am-9:50am: Attendees arrive and find seats in their assigned Session ONE room
9:50am-11:00am: Session One
11:10am-12:20pm: Session Two
12:20pm-12:50pm: Lunch Break
1:00pm-2:00pm: Session Three
Optional 2:15pm-3:15pm: Late Session Workshops

PLEASE READ
Registered attendees and school groups attending for the full day* will be assigned to:
– ONE session participating in a hands-on workshop**
– TWO sessions seated in the main stage area to view speaker presentations and participate in Q&A sessions (each session will feature up to 2 speakers)
*We understand that sometimes schools need to arrive late or leave the event early. Due to limited seating, we will try our best but cannot guarantee early departing OR late arriving schools seats in a hands-on workshop.
**Due to limited seating, we are unable to take requests for specific speakers or workshops.

I understand that my students will be assigned to TWO speaker presentation sessions and ONE workshop session

Please tell us if you are able to stay for the full day of X-STEM

We are able to stay for the full event time from 9:30am-2:00pm
We cannot stay for the full event AND understand that we are not guaranteed a hands-on workshop assignment due to our early departure or late arrival.
Other (explain below)

Explain

Workshop space is limited and we may offer an additional late-session workshop from 2:15-3:15pm to allow all students the opportunity to participate in a hands-on workshop. If so, tell us your availability:*

My student(s) are able to attend a late-session workshop from 2:15-3:15pm
My student(s) must depart the event at 2pm and cannot attend a late-session workshop

How did you hear about this event?*

Please read and provide your electronic signature below:

Attendee Waiver
Participation in the USA Science & Engineering Festival (“X-STEM”) is at your own risk. By participating in X-STEM, you agree that Science Spark and its organizers, employees, consultants, directors and any of its agents as well as the sponsors, exhibitors, speakers, and volunteers of X-STEM cannot be held liable for any loss, damage, injury or other liability resulting from you, your child or your student's participation at the USA Science & Engineering Festival, and that Science Spark and its organizers, employees, consultants, directors and any of its agents cannot be held liable for speaker, sponsor, or exhibitor content or activities at X-STEM.
By attending X-STEM, you understand that you may be photographed, videotaped, or recorded. You grant permission for the USA Science & Engineering Festival and its organizers, sponsors and exhibitors to use your image or voice in all forms of media as permitted by law, without compensation to you. You waive the right to inspect or approve versions of your image or voice or the written copy that may be used in connection with the foregoing.

Student Rules and Regulations:
While in attendance at X-STEM, all students must abide by the standards for student behavior enforced by their school so that we can provide a safe (and fun!) learning environment outside of the classroom. Additionally, please see the following attendee rules:
- No student backpacks will be permitted inside the convention center. Small cinch packs are acceptable for students. Adult chaperones may carry a standard backpack.
- Attendees are responsible for carrying personal belongings with them at all times (includes lunches and cinch packs). We will NOT have a holding area for student or chaperone belongings.
All bags will be subject to search by security or Festival staff
- Students must be quiet and courteous during presentations and workshops.
- Attendees MUST bring their own lunch. Food will NOT be available for purchase. NO outside purchased food is allowed on the convention center grounds (no uber eats or food delivery service, chaperones may NOT purchase food from outside the convention center and bring it to their students). All food must be consumed in designated lunch areas outside of the convention center. Attendees are responsible for discarding their own trash before leaving the lunch areas.
- We recommend one adult chaperone per ten student attendees.
- Students must be quiet and courteous during presentations and workshops.

I have read and understand the Waiver and event rules above:

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Organization

X-STEM NOVA Registration 2023

X-STEM NOVA 2023 Attendee Registration

Registrant Contact Information

School or Organization Information

Attendee Information

Grade Level of Attendees

HOW MANY of your attendees identify gender as:

HOW MANY of your attendees identify race/ethnicity as:

Additional Information

Please read and provide your electronic signature below:

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