Name *

First Name

Last Name

Phone Number *

(###)

###

####

Address *

This workshop is open to students living in the LA or Fort Worth areas.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you able to participate in the online from July 14-18th, 10am-12 pm PDT (Los Angeles) / 12 pm-2 pm CDT (Ft. Worth)? *

Yes

No

This is an online workshop. Do you have your own laptop with Zoom and Chrome browser installed that you can use for the duration of the workshop? *

Yes

No