STEMPosium Sign Up

Full Legal Name

First

Last

Phone Number

Cellular or mobile is preferred. We ask for this because military requirements could cancel your tour, even once confirmed. It hasn't happened often, but it has happened

E-Mail

Confirm

Using one e-mail for your group is fine, if you'd prefer.

Birthdate

Birth Place

City and State, if born in the United States. If born in another country, outside of the United States, then we need city and country.

Country Of Citizenship

Which country are you a citizen of? Which country issued your passport?

ID Number

Please supply the complete ID number from what you selected above. For DL, also provide state issued. For social security, please provide the last 6 numbers. Please use "Minor" if under 18 yrs old.

Residential Address

Unit

Street

City

Region

Country

Zip

Please provide your physical residential address. NOT your mailing address.

Special Needs

YES
NO*

Does anyone in your group use special medical equipment, like a wheelchair, walker, a portable oxygen device, have a service animal, or have any other special needs?

Special Needs Request

If you selected YES above, please provide any special requests you have.

EDWARDS AIR FORCE BASE STEMPOSIUM SIGN UP

You must fill out this form to attend the STEMPosium on 14 November 2019