Introduce a Girl to Engineering Day Kit Request
and National Pledge Roster

Name:

Address Line 1:

Address Line 2:

City:

State:         Zip Code:   
E-Mail:

Employer:

Engineering Society or Student Chapter

A:
My employer/engineering society/organization wishes to participate. Please list us among participating organizations. Yes   No

If yes, please list your web page: and we will provide a link from the Engineers Week site. We ask that you link back. You can pull off the icon on our index page.

If yes, please complete the remainder of Section A and also tell us briefly about your plans for participation:

Our organization/company goal is to encourage:
engineers participating in Introduce a Girl to Engineering Day, including women, to reach girls in K-12.

B:
I wish to participate alone.
Please include me on the National Pledge Roster. Here is a brief description of my plans:

I intend to reach of girls in grades K-12.

C:
For Introduce a Girl to Engineering Day 2013, it would be helpful to have: