Mid-Atlantic Gigabit Innovation Collaboratory(MAGIC)

Contact Information

Name

First Name

Last Name

Zip Code

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Email

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Emergency Contact Name

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Attending School

Education Level

Participating Location

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I will be participating at this location

Additional Event Information

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Area of Interest

What is your area of interest? Select all that apply

Software Development

Graphic Design

Marketing

Business/Finance

Will you need to be placed on a team?

Yes (I need a team)

No (I already have a team)

Team Information

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Will you need a Laptop?

T-Shirt Size

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Food Restrictions

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Media Waiver

I hereby consent to the use of my name, likeness, picture, and/or voice by the Mid-Atlantic Gigabit Innovation Collaboratory, Inc. (MAGIC) for broadcast, promotion, direct exhibition, and subsidiary purposes. Such uses will not be made as direct endorsement of any product or service. I hereby indemnify you and your licensees respecting any claim arising from my actions or statements on the program. No compensation will be received in exchange for permissions granted here

Acceptance

*

Yes, I consent to the media release