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DEVILS LAKE, ND

LAKE REGION STATE COLLEGE

GRADES 6-8 ~
WEDNESDAY, JANUARY 21, 2026

GRADES 9-12 ~
THURSDAY, JANUARY 22, 2026

Name*

Title*

Company/Organization Name*

Email*

Website Link

Mailing Address*

Physical Address

City*

State*

Zip Code*

Phone*

Additional Presenter Information (Name/Title/Company/Email)

Title of Session/Activity/Demonstration*

Description of Session/Activity/Demonstration (a brief summary, including detailed information on any hands-on activities)*

Do you want to be assigned a classroom? *

Yes

No

I don't want a classroom, I need additional space for my session.

Additional Requests (Total space required for session, do you have any equipment or simulators that will require extra room?)*

Would you like to be provided with lunch? *

Yes

No

Presenter/Facilitator Registration Form

CONTACT:

Shawn Brink, ND Energy Education Coordinator

Call

Shawn Brink: 701-471-2897

Kent Ellis: 701-426-4891

Contact

shawn_brink@bismarckschools.org

© 2021 by

ND T4 Summit

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