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Rensselaer Polytechnic Institute (RPI)
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Black Families Technology Awareness Day 2021 Participant Registration Form
Please enter information on
each member of your family
who wishes to participate in the event in February. You will be sent information through email to register for specific program sessions once you submit this form.
Contact Information
Name of Family Contact Person
Email Address
Repeat Email Address
Phone Number
Address
Address
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Street
City
Region
Postal Code
Participant Information
Participant Contact Information
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_ID_
Name
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Adult
Grade K-2
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Grade 9-12
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