Name* First Last Title/Position* School* School Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* What field trip(s) are you interested in? Estimated times are included, but can be adjusted based on group needs.* Genetic Transformation and Bioluminescence (2 hours) DNA and Principles of Gel Electrophoresis (2 hours) Scientific Inquiry and DNA Extraction from Fruit (2 hours) Restriction Enzyme Digest and Gel Electrophoresis of DNA (3 hours) Immunology (3 hours) Polymerase Chain Reaction for Genetic Screening (3 hours) Bioluminescence II - Serial Dilution with Luciferase (2 hours) PCR to Detect Genetically Modified Organisms (5 hours with lunch break) Short Tandem Repeats and Genetic Identity (5 hours with lunch break) Restriction Enzyme Digest for Inquiry (5 hours with lunch break) Other / Custom At this time, our calendar is fully booked for the 2023-2024 school year. What dates, days, and/or times work well for you?*How many students, what class and/or grade level?*If you're bringing 15 students or less and would like to pair up with another small group, please*If you're bringing 15 students or less and would like to pair up with another small group, please indicate so below. Pairing up with another school is dependent on schedules and is not guaranteed. Your email will be shared with other groups. I would let another school join our field trip but my days are not flexible. I would be interested in joining another school's field trip if they are doing the same labs as me, flexible on day/time in order to make that happen. I would be interested in joining another school's field trip, flexible on labs and day/time in order to make that happen. What field trip format are you interested in? In person at BTC Institute On The Road at your school Virtual Logistics - Anything else you'd like us to know related to timing or topics? If you have any goals or objectives for your students during this experience please let us know.Untitled First Choice Second Choice Third Choice