First Name

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Job Title Please indicate your job title or if you are an undergraduate, professional or graduate student.

Employer or School Name

College affiliation(s) Please list the colleges or universities you attended or are attending. Use comma to separate values.

High School Affiliations Where did you go to high school? Please include city and state.

STEM areas of work or interest BiochemistryBiologyChemistryComputer Science/EngineeringEarth ScienceEcologyEngineeringEnvironmental ScienceLife ScienceMathMedicineMolecular BiologyotherPhysicsResearchPlease select the subject areas that are closest to your work/interests/studies. *you may select multiple options

Previous GAINS Events GAINS Conference 2015GAINS Conference 2016GAINS Conference 2017GAINS Conference 2018GAINS Conference 2019GAINS Conference 2020GAINS online event: panelGAINS online event: webinarSchool visitotherHave you volunteered at a past GAINS event? You may select multiple options.

Professional Information Please provide a link to your professional profile: bio, cv, faculty page, LinkedIn, etc....

Event types panel discussion (online)small group discussion (online)webinarSTEM toursocial media eventrecorded interview or panel event (online)otherschool visit/in-person talkPlease select any event formats that are of particular interest to you. **you may select multiples

Street Address (Mailing/shipping)

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