4th Annual Green Chemistry Commitment (GCC) Summit Registration and Presurvey

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Please complete the form below to register for the Green Chemistry Commitment (GCC) Summit and to express your interests for the Summit as well as how you would like to be involved. The community interests and needs will determine portions of the virtual event so please do give us your input and ideas. The Summit will be hosted in Zoom on June 24th from 11:00 - 3:00 PM ET.

Please provide your contact information: Name and Institutional affiliation. *

What email address would you like to use for communication about the Summit and post-Summit follow up? *

Can we share your contact information with GCC Summit participants? *

Yes

Please select all of the following that apply to you. *

Faculty member from a Green Chemistry Commitment Signing Institution

Staff member from a Green Chemistry Commitment Signing Institution

Undergraduate or Graduate student from a Green Chemistry Commitment Signing Institution

Faculty member, staff or student from a USA based Institution

Faculty member, staff or student from an international Institution

Faculty member, staff or student from a Dow academic partner Institution

Green Chemistry Commitment Supporter with Industry, Government or NGO, etc. Affiliation

Green Chemistry Commitment Advisory Board Member

Other:

Required

We plan to post/share the video recording of this Summit. While it is expected that the video feed will focus on the presenter, your voice and video feed could appear at some point. Do you give your consent to allow us to post video and/or sound of you? *

Yes

We plan to post/share photos of this Summit. Do you give your consent to allow us to post pictures of you in our newsletter and on our social media accounts? *

Yes

Do you have a social media account you would like to use for sharing and tagging? Please specify the platform and username if you would like to be tagged.

What are you hoping to get out of this year's Summit? *

Do you have a Green Chemistry resource (lab, activity, resource, etc.) that you would like to share with during the Summit in an open-access format? Deadline for submission would be 6/23 by midnight ET! *

Yes

Maybe

Do you want to give a quick update on one 16:9 slide or multiple slides converted into a gif of your work or your departments advances in Green Chemistry Education over the past year? Deadline for submission would be 6/23 by midnight ET! *

Yes - I'd like more details

Other:

Would you like to create and share a 2-3 minute video about the Green Chemistry education initiative at your institution? Deadline for submission would be 6/23 by midnight ET! *

Yes - send me the guidance document for video development and submission.

Maybe - I need more information

We will have some breakout rooms for networking and smaller discussions. Who are you most interested in talking to? *

My colleagues so we can discuss our Green Chemistry education aims

Other GCC signers

Other implementing Green Chemistry education in their courses

Others about Green Chemistry laboratory experiments

Others about incorporating Toxicology concepts into chemistry courses

Beyond Benign staff about the Green Chemistry Commitment Program

Required

Any ideas, feedback and or suggestions to make this a great virtual Summit can be submitted below. We look forward to making this a great virtual event with your help!

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