Registration Type: Select Chaperone Student JA USA Staff Judge Sponsor Team Guest Wednesday Evening Guest
Personal Information
First Name
Last Name
Full Name as it should appear on your name badge
Preferred Pronouns Please select He/Him/His She/Her/Hers They/Them/Theirs No preference Other Other
Do you want your pronoun on your namebadge? Company/Organization
Job Title
Email
You will receive an email from Background Information Services (BIS) for a confidential background check.
Home Address
Work Phone Number
Cell Phone
Role of Chaperone Please select Educator JA Staff Parent Volunteer Other
Birth Date
Age
School Name
School's NINE-digit Zip Code (https://tools.usps.com/zip-code-lookup.htm)
Dietary Restrictions (select all that apply) T-Shirt Size (Unisex) Please select XSmall Small Medium Large XLarge XXLarge XXXLarge XXXXLarge
Emergency Contact Name and Phone
In order to accommodate any and all disabilities, please provide a brief description of any disabilities you may have and any specific accommodations you require.
Please list any medical needs, medications, and/or allergies.
Student Company/Team Information
Which student competition are you associated with? Please select Company of the Year (COY) Social Innovation Challenge (SIC) Stock Market Challenge (SMC) Titan Challenge
Which COY student company are you associated with? Please select COY Team 1 COY Team 2 COY Team 3 COY Team 4 COY Team 5 COY Team 6 COY Team 7 COY Team 8 COY Team 9 COY Team 10 COY Team 11 COY Team 12 COY Team 13 COY Team 14 COY Team 15
Which SIC student company are you associated with? Please select SIC Team 1 SIC Team 2 SIC Team 3 SIC Team 4 SIC Team 5 SIC Team 6 SIC Team 7 SIC Team 8 SIC Team 9 SIC Team 10 SIC Team 11 SIC Team 12 SIC Team 13 SIC Team 14 SIC Team 15
Which SMC student team are you associated with? Please select SMC Team 1 SMC Team 2 SMC Team 3 SMC Team 4 SMC Team 5 SMC Team 6 SMC Team 7 SMC Team 8 SMC Team 9 SMC Team 10 SMC Team 11 SMC Team 12 SMC Team 13 SMC Team 14 SMC Team 15 SMC Team 16 SMC Team 17 SMC Team 18 SMC Team 19 SMC Team 20
Which Titan Challenge student team are you associated with? Please select Titan Team 1 Titan Team 2 Titan Team 3 Titan Team 4 Titan Team 5 Titan Team 6 Titan Team 7 Titan Team 8 Titan Team 9 Titan Team 10 Titan Team 11 Titan Team 12 Titan Team 13 Titan Team 14 Titan Team 15 Titan Team 16 Titan Team 17 Titan Team 18 Titan Team 19 Titan Team 20
Does your company/team have a web presence?
Please provide a one-two sentence description of your company/team and product that will be shared with judges and the public. Please write the description in the third person starting with the company/team name.
If your student company/team is supported by a sponsor, please list all sponsors here (if this does not apply, please type "none").
Does your student company/team plan on flying or driving to the Atlanta, GA? Please select Flying Driving
Agenda
Please select which events you are attending.
Monday
Breakfast in the Dorm Cafeteria? Site Visit? Please select Yes - Delta Yes - Chic-fil-A Yes - Staples Yes - Pacific Life Yes - Mercedes No
Tuesday
JA USA will assign a workshop to you depending on the final placement of the students from your team.
Please rank the workshops listed below in your order of preference: first choice, second choice, and third choice. Please note, you will only attend one of these workshops.
Round 1 (Creative Collaboration):
Stock Market Challenge Light Please select 1st Choice 2nd Choice 3rd Choice
Leadership Please select 1st Choice 2nd Choice 3rd Choice
Brand and Marketing Please select 1st Choice 2nd Choice 3rd Choice
Round 2 (Developing Personal and Professional Skills):
Networking Please select 1st Choice 2nd Choice 3rd Choice
Interview Skills Please select 1st Choice 2nd Choice 3rd Choice
Professional Skills Please select 1st Choice 2nd Choice 3rd Choice
Breakfast in the Dorm Cafeteria? Workshops - Round 1 Please select Stock Market Challenge Light Leadership Brand and Marketing
Workshops - Round 2 Please select Networking Interview Skills Professional Skills
Dinner in the Dorm Cafeteria? Wednesday
Breakfast in the Dorm Cafeteria? Company of the Year Presentations? Social Innovation Challenge Presentations? Lunch in the Dorm Cafeteria? Travel Information
Guest are required to stay with their students on campus. JA USA will accommodate two guests per team through the reserved dorm room block. Additional guests needing rooms must make their own arrangements for lodging.
JA USA will handle your room reservations. Please provide your travel details below.
JA USA has secured a group room block at Hotel Indigo. Please let us know if you will need a hotel room during your stay in Atlanta, and we will reach out with a reservation link.
Will you need a hotel room? Arrival Date and Time
Arrival Airport
Arrival Airline and Flight Number
Packages Select Package Team Guests Wed Evening Guest 0.0
0.0
Payment Section Select Payment Method Stripe (Stripe)
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