Visiting Scientist - Volunteer Registration

Volunteer Registration

Contact Information

Title

First Name*

Last Name*

Address*

Address (cont.)

City*

State*

Zip Code*

Work Phone

Evening Phone

Mobile Phone

Fax

Preferred Contact Method
Work Phone
Evening Phone
Mobile Phone
Email

Credentials

Position/Job Title

Organization

Degree(s) or Certifications

Interests

I am interested in the following categories of outreach opportunities (check all that might apply)
Speaking to student groups
Speaking to teacher(s) groups
Speaking to parents
Performing a hands-on activity with students
Hosting a student field trip
Hosting a student intern
Hosting a teacher intern
Participating in an externship (where I would work with students on a project at their site, or via videoconference)
Mentoring a student or teacher (e.g. periodic contacts over a six month to a year time frame)
Judging a science fair or competition
Donating lab supplies, equipment or materials to school class
Other

Topics you would like to address
Careers in life sciences: lab based
Careers in life sciences: non-laboratory careers
Bio Ethics
Science and Business / Entrepreneurial Experiences
Drug development
Genetic testing
Infectious Diseases / Vaccines
Regenerative Medicine
Biotechnology in Agriculture
Bioenergy

Other interests, areas of expertise, comments or questions

Availability

I prefer to work with the following age levels (check all that apply)
Elementary
Middle School
High School
Post Secondary
No Preference

I prefer to speak in the following counties or regions (check all that apply)
Metro Atlanta
Athens
Augusta
North Georgia
Central Georgia
Southern Georgia
Where I'm Needed
Other

I am available (check all that apply)
School day
Afterschool program
Evening program
Saturday morning program
When Needed

I would be willing to participate in outreach
Once a year
Several times per year
More frequently for special projects
Whenever I can based on availability

Enter the code shown above

* Required

Home
About Us
Events
News
Programs
Resources
Career Info
Contact Us
We Love Biotech!