2021-22 NEXT Registration

NEXT Registration

• Name*
  First Last
• Email*
• Secondary Email
• Mobile Phone*
• Address*
  Street Address Address Line 2 City State ZIP / Postal Code
• School*
• Teacher*
• Grade*
• Parent or Guardian Email*
• Additional Parent or Guardian Email
• Are you be interested in a internship opportunity with a startup and small business?*
  • Yes
  • No
  • Ask me later
• If Square1 is interested in pursuing my idea, I agree to either work with them to launch my idea, negotiate an ownerships share, or relinquish rights to my idea to Square1.*
  • Yes
  • No
  • Ask me later
• You grant Square1 permission to use images or videos that include you. (Social media/marketing purposes only.)*
  • Yes
  • No
• Please type your name and today's date as a means of signing/certifying this form.*
• Comments
  This field is for validation purposes and should be left unchanged.