Test Rereg TAME Club Registration Form "*" indicates required fields Step 1 of 4 25% TAME CLUB: 2023-2024 ANNUAL REGISTRATIONAdult Club Leader - Person completing this form and primary point of contact; supervising liaison who recruits and registers the club and students, hosts the meeting and organizes and facilitates activities during TAME Club meetings and events Adult Co-Leader (optional) - additional point of contact; helps with recruitment, registration, planning, activities, etc.CLUB TYPE: SELECT ONE OF THE FOLLOWING ONLYClub Type* Texas School Community Organization - (Engineering service organization like NSBE Jr., IEEE, Scouting, 4H, etc.) Unaffiliated - (Group of students not affiliated with any school or community organization.) School/Organization Name or Club Name for Unaffiliated Club* The name of the school or community group, such as "Gonzalez High School" or "Girl Scout Troup 123." If you are not affiliated with a school or organization, use a descriptive name for your club that your students will recognize.TAME Club Name Create a TAME Club name to identify your group. ADULT LEADER INFORMATIONAdult Leader First Name* Adult Leader Last Name* Preferred name for nametags Salutation*Select OneMs.Mr.Dr.Mrs.Prefer noneHow do you pronounce your name? What are your pronouns?Select oneShe/herHe/himThey/themAdditional pronounsPrefer not to answerWhat are your pronouns? Leader email* Alternate email Backup in case of issues with school firewalls.Leader work phone*Cell phone*T-Shirt Size*Select oneSmallMediumLargeX-Large2XL3XL4XL5XLGender identity - Do you think of yourself as:*Select oneFemaleMaleTransgender woman/trans woman Transgender man/trans man Genderqueer, non-binary, or other gender nonconforming Additional gender categoryPrefer not to answerPlease specify additional gender Are you Hispanic or Latino?* Yes No Prefer not to answer What is your race?*Check all that apply. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Additional Prefer not to answer Ethnicity: Additional* Is this your first time sponsoring a TAME Club?* Yes No Dietary needs*Check all that apply. None Vegetarian Gluten-free Vegan Dairy-free Other Dietary (other)*Please describe your dietary needs. CLUB INFORMATIONTAME Region/TEA Region*Select optionAbilene – Region 14Amarillo – Region 16Capital Area (Austin) – Region 13Costal Bend (Corpus Christi) – Region 2Dallas – Region 10East Texas – Region 7El Paso – Region 19Fort Worth – Region 11Golden Triangle (Beaumont) – Region 5Gulf Coast (Houston) – Region 4Huntsville – Region 6Lubbock – Region 17Mount Pleasant – Region 8San Angelo – Region 15San Antonio – Region 20Valley – Region 1Victoria – Region 3Waco – Region 12West Texas (Midland, Odessa, Fort Stockton) – Region 18Wichita Falls – Region 9School District* Include the name of your school district.Is your club at a Title I School?* Yes No To be considered a Title I school, a minimum of 40% of the students must qualify for free or reduced lunch. You can check the status of your school using this link.List the name of my Club on my Region page of the TAME website?* Yes No Registered TAME Clubs have the choice to be listed on your Region page of the website to help students, parents, and local partners know how TAME is present in a community. This listing will show the name of your school or organization. It will not show any other identifying data and is optional.Is this TAME Club new, or renewing?* New Renewing Does your club have additional adult leaders? If so, you'll be able to register them once your Club Registration is complete.* Yes No Building*Name of building where you meet. Street Address* Address 2 City* State / Province* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code* Ship my toolkit to* the address provided above a different address Name of building Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Is this a residential address?* yes no For my toolkit, I would prefer a gift card from* Amazon Walmart LEADER CERTIFICATIONPlease check to confirm that you understand and agree to the following requirements for your TAME Club:* My TAME Club will recruit at least 8 student participants. All participants in my club are in grades 6 – 12 If my TAME Club is not located at a Title I school, I will recruit students so that at least 60% of students members are from TAME focus student groups. I will coordinate regular meetings about engineering topics for my club members. I will provide my students with the registration link and have them register online. By signing below I affirm that all of the above statements are true and that my group is eligible to register as a TAME Club. I understand that TAME can cancel my membership at any time if it is determined that my group is ineligible. Release: I will participate in TAME Club Events, the Regional Competition and, if selected, the TAME State Competition (collectively, “TAME Events”). THEREFORE, FOR (I) MYSELF; (II) MY LEGAL REPRESENTATIVES; AND (III) MY HEIRS AND ASSIGNS; I HEREBY RELEASE AND FOREVER DISCHARGE TAME, ITS SPONSORSHIP PARTNERS OR OTHER EVENT SPONSORS, THEIR MEMBERS, DIRECTORS, MANAGERS, OFFICERS, AGENTS, AND/OR EMPLOYEES (THE “RELEASEES”), OF AND FROM ANY AND EVERY CLAIM, DEMAND, DAMAGE, INJURY, OR CAUSE OR RIGHT OF ACTION OF WHATEVER KIND OR NATURE EITHER IN LAW OR EQUITY, ARISING FROM ACCESS TO AND PARTICIPATION IN THE TAME EVENTS, EVEN IF CAUSED BY THE NEGLIGENT ACT OR OMISSION OF THE RELEASEES. Photography: I grant permission for TAME, designated TAME representatives, and TAME partners or sponsors to use any photos, film, or videos of me, or my likeness, and any quotes or statements given by me, orally or in writing, without restrictions, in any media, in legitimate accounts and promotions of this event. I hereby certify that I am at least 18 years old and give this waiver and release freely and knowingly with full understanding of its content and effect. Furthermore, I release full understanding of its content and effect. Date MM slash DD slash YYYY Signature*HiddenAccessibility Needs Yes No HiddenPlease describe your needs HiddenSpecify school typeSelect onePublic SchoolPrivate SchoolCharter SchoolHome SchoolVirtual SchoolHiddenMailing address (if different from meeting location - Toolkits will be shipped to this address) For event planning purposes (such as Divisional and State STEM Competitions):I understand that if my TAME Club is not at a Title 1 School, I need to recruit students so that at least 60% of student members are from TAME Focus Student groups that are underrepresented in engineering: Students who are Black/African American, Hispanic/Latinx, or Indigenous/Native American Female students HiddenMy club is located in Austin, Dallas, Fort Worth, Houston, San Antonio or in a suburb of one of these cities. I will recruit students so that at least 50% of the club members meet one of the following criteria – Would be first in their family to graduate college : Yes At a Title I school Great! You will be able to register your Co-Leader after you complete this registration.HiddenAdditional ContactsNameSalutationEmail Add RemovePlease list adults besides Co-Leaders you would like to be included in your TAME Club's emails about registration, toolkits, or Competition (these emails may contain private student data). Example: your school's principal or support staff in your organization.HiddenMedications HiddenMedical Needs Medications Medical Conditions None HiddenMedications HiddenMedical Conditions HiddenDo you have an active certification in First Aid/CPR? First Aid CPR Neither HiddenStudent LeadersNameEmail Add RemovePlease list any students helping you lead the club (such as a Club President, Team Captain, Recruitment Officer, etc.) who you want to include in general emails about deadlines, competitions, scholarships, contests, etc. These emails will not include rosters or private student data. NOTE: This is not where you register students. HiddenUsername HiddenUntitled First Choice Second Choice Third Choice EmailThis field is for validation purposes and should be left unchanged.
