Registration – AMP Conference

AMP Conference

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

This is where all event information will be sent to. Make sure you can receive emails from nmmesa.org.

Enter Email Confirm Email

Phone*

Gender

Ethnicity*

Race*

High School*

Grade*

Is intended college major STEM?*

Yes

N/A Teacher Advisor

Parent/Guardian Name

Complete if a Student, Leave Blank if a Teacher Advisor

First Last

Parent/Guardian Email

Complete if a Student, Leave Blank if a Teacher Advisor

Parent/Guardian Phone

Complete if a Student, Leave Blank if a Teacher Advisor

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

If a Teacher, How many Students are attending from your School?

If a Teacher, How many Advisors are attending from your School?

If a Teacher, What are you Requesting to be paid by NM MESA?

If requesting transportation a B4 must be submitted to anita@nmmesa.org. If requesting lodging, please note any lodging requests in the next question.

Lodging

Transportation

Nothing

Anything else we need to know? Attendance, lodging request, other?

Registration – AMP Conference

AMP Conference

New Mexico MESA Inc.