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.*
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