Ignite Your Superpower 2019 Registration Question Title * 1. Contact Information Name Company Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Phone Number Question Title * 2. Day of Event Point of Contact Name Company Email Address Phone Number Question Title * 3. Please provide a brief description of your booth, activity, or demonstration. This will help us describe your experience to students and teachers prior to their visit. Question Title * 4. What size of area will you need for your booth or experience? 10' x 10' 10' x 20' 20' x 20' 20' x 30' 30' x 30' If other, please describe your needs: Question Title * 5. Will you like/need space outdoors for your experience or activity? (Please be aware we cannot guarantee specific space inside or out, but we will do our best and follow up with you on locations.) Yes - it would be nice No - we prefer to be indoors Not sure at this time It is critical that our space is outdoors Comments Question Title * 6. How many tables will you need? 1 2 3 4 5 If more than 5, please let us know how many: Question Title * 7. How many chairs will you need? 1 2 3 4 5 6 7 8 9 10 If more than 10, please let us know how many: Question Title * 8. Do you need access to electricity? Yes No Not sure If yes, how much do you need? Question Title * 9. Do you need access to WiFi? Yes No Not sure If yes, how many devices will need access? Question Title * 10. Do you need access to water? Yes No Not sure If yes, approximately how many gallons? Question Title * 11. Approximately, how many volunteers/staff will you bring to the event? You are not locked into this number. We will follow up closer to the event for a final count and names of those working your experience. 1 2 3 4 5 6 7 8 9 10+ 15+ Question Title * 12. Do you have any questions, or have any additional needs not addressed above? Done - Thank you!