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TechWise for Women Registration
Contact Information
Student Name
*
First Name
Last Name
Student Email
If no student email, please add parent email.
Verify Email
Student Phone
If no student phone, please add parent phone number.
School
*
Grade
*
Age
*
Student Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Mom or Female Relative Name
First Name
Last Name
Mom or Female Relative Email
Verify Email
Mom or Female Relative Phone
Date
(mm/dd/yyyy)
Are you a member of the Girl Scouts of WNY?
*
Yes
No
Have you participated in Girls Coding in the past?
*
Yes
No
If yes, was it at the Beginner or Advanced level?
Does Mom have any experience with Coding?
Yes
No
If yes, what kind of experience?
Have you invited someone else to participate? If so, what is their name?
Does the person you invited have any coding experience?
Yes
No
Are there any dates you cannot attend?
