1.Name:

2.Email:

3.Office:

Atlanta, GA

Battle Creek, MI

Cambridge, Canada (IFAB)

Field Team

Salt Lake City, UT

San Diego, CA

São Paulo, Brazil

Springfield, MA

Toronto, Canada

4.Are you interested in being a mentor?

Yes

No

5.Are you interested in joining a local society of women engineers (SWE) or women in science and engineering (WiSE)?

Yes

No

6.If the answer to the above is "yes", what school is your alma mater?