PERUGIN Conference Registration Form
HOW TO REGISTER/EDIT YOUR RESPONSES:
After you submit this form, you will be given the choice to "edit your responses," You must click on "edit your responses," then bookmark the page for later use. Alternatively, you can also copy and save the address in the browser address bar.
**The responses to this form are resumable and editable. If you wish to register students and advisors first, then enter their workshop presentation information at a later time, you may do so. To submit information at different times, be sure to go through the whole registration form until you are able to press submit. Once you press submit, you will be taken to a submission page that will hold a link to your form submission. Copy this link and put it somewhere safe so that you can return to the same saved form and complete your registration form. Please be sure to submit all information by the deadline.

1. REGISTER: Registration Fees for Incoming International Participating GIN School Project Teams:
$240 USD for BOTH students and advisors.
***Local Schools please contact FDR

DEADLINE FOR REGISTRATION & REGISTRATION PAYMENT IS MARCH 14th, 2019

REGISTRATION FEE INCLUDES:
All conference activities, conference meals, airport and daily transportation to and from the hotel.

1a. BE PREPARED TO SUBMIT THE FOLLOWING FOR GIN PROJECT TEAMS:
School Name
Host Country
Pre Conference/ Post Conference Programming
Full Name of Person Completing Registration
Person Completing Registration Email Contact
Full Name of a Finance Officer at your school
Contact of a Finance Officer at your school
Full Name of Emergency Contact
Emergency Contacts
Full Names of GIN Advisors
Contacts for All GIN Advisors (Email)
Total number of attendees from your school
Total number of teams
Student dietary, medical and accessibility needs
Flight Arrival and Departure Information
Finalized confirmation from hotel for reservations
Student GIN Project Team Information:
Team #, Global Issues & Name
Full Name of All Students of Team #
Corresponding Email for all Students on Team #
Grade Level
Workshop Title
GIN Project Global Issue
GIN Project Essential Question
GIN Project Impact Statement
GIN Project Description
Plan for Sustainability
Workshop Lesson Plan
Workshop Presentation Video: Film your Workshop Presentation, upload and submit shared youtube link
Film Festival Submission: Film Festival Youtube URL
REVIEW AND FOLLOW ALL GIN TEAM GUIDELINES:
GIN PROJECT WORKSHOP
Plan and develop your GIN Project Workshop using the guidelines outlined in the GIN Workshop Guide: http://globalissuesnetwork.org/student-workshop-guidelines/
Make sure to film and submit your GIN Project Team Workshop Video: Uploading your video to youtube and submitting a shareable link in the conference registration form.
FILM FESTIVAL SUBMISSION
Filming and submitting your Film Festival Video:
http://globalissuesnetwork.org/film-festival-guidelines/

1c. REGISTRATION FEE DETAILS:
Additional international and national wire transfer fees must be covered by visiting schools
PLEASE CONTACT YOUR BANK DIRECTLY FOR MORE INFORMATION TO ENSURE YOU HAVE PLANNED FOR ALL COSTS

1d. FDR GIN CONFERENCE REGISTRATION INVOICES:
After registering you will receive an invoice with instructions for payment for bank wire transfer.

2. WE WILL RESERVE YOUR TRANSPORTATION
We will use the information you submit in the GIN Team Conference Registration Form to book your Airport Transportation.
You will receive a request to confirm numbers, arrivals, departures and flight information upon final submission of Registration.
** Please be sure to update us should there be any changes in numbers or flights.

3. BOOKING HOTEL RESERVATIONS FOR THE GIN CONFERENCE:
HOTEL costs will be paid by each school directly to the hotel and are NOT covered by the conference fee.

HOTEL Reservation Form, contact information, and rates. Make a copy, add your information, and send this form to the hotel contact directly: https://docs.google.com/document/d/1BUDS5K-3NKAYI4tJbHgkwROO6xfcDO9eVOidWjMJtVs/edit?usp=sharing

Please CC FDR so that we may support you: perugin@amersol.edu.pe
DAZZLER HOTEL Direct Contact (should you have any questions or concerns):
Mrs. Nathalie Yepez
E-mail: nyepez@dazzlerlima.com
Tel: (51-1) 634 4001

HOTEL RESERVATION DEADLINE IS MARCH 25th, 2019
PLEASE RESERVE YOUR HOTEL ROOMS AS SOON AS POSSIBLE!

4. VISAS
Please double check visa requirement given the nationalities of your participating students and educators. Please double check and follow your host country’s requirements and deadlines for visas.
Please make sure that all participants have a blank page in their passport. You will be issued a tourist visa upon arrival as part of the Peruvian immigration process.

5. TRAVELING WITH MINORS- LEGAL GUARDIAN/PARENTAL CONSENT FORM:
Please check with local immigration authorities about specific requirements. Minors may necessitate parent permission to travel. Some requirements may include a parent permission from a notary, copy of birth certificate, proof of return flight, travel dates, hotel info, event info, and advisor information. Again, please check and come prepared with any and all of the above as needed.
Please feel free to use the following Legal Guardian/Parent Consent Form: CLICK HERE.

6. VACCINES
Please check and follow your host country’s vaccine requirements for all student and educator participants.

7. DRESS CODE:
Business Casual/ Easy and comfortable movement
Ex: Comfortable and supportive shoes, jeans/comfortable slacks/easy to move in dresses/skirts, t-shirt/collared shirts
Please no: holes, rips, inappropriate words or images, or hard to move in clothes.

8. CODE OF CONDUCT
- We are here to exchange and innovate solutions to complex problems. Come prepared to collaborate with empathy and work hard!
- Substance abuse will not be tolerated- zero tolerance policy
- Disrespect, discrimination and bullying will not be tolerated- zero tolerance policy
- Students and advisors need their sleep, you will be asked to respect each other and take care of yourself by adhering to the set curfew.
- No visiting with each other in sleeping areas/rooms. Students will be expected to meet and visit after conference hours in public and common areas with advisor chaperones present.

STUDENTS WHO BREAK THE CODE OF CONDUCT:
Students and parents must be made aware that if students are found breaking the code of conduct, they will be asked to leave the conference and may be asked to fly home early with an advisor chaperone. The student's family will be responsible for the extra costs.

Email address *
WELCOME TO THE PERUGIN CONFERENCE REGISTRATION
Full Name of School *
Please write the full name of the school you are representing. If your school shares a popular name, ex: Lincoln, please share the city and country you are joining us from as well. Thank you.
Your answer
City *
Your answer
Country *
Your answer
Person Registering Student Teams *
First and Last Name
Your answer
Position at your school. *
Your answer
Email Address *
Your answer
Name of contact in business department *
This is the person that will be in charge of making payments at your school.
Your answer
Email of business department contact *
Your answer
Emergency Contact Full Name *
Your answer
Emergency Contact *
Your answer
GIN Advisors
Each school is required to send at least two adult advisors as chaperones. Please provide their information in this section.
Advisor 1: Full Name *
Your answer
Advisor 1: Contact *
Your answer
Advisor 2: Full Name *
Your answer
Advisor 2: Contact *
Your answer
Advisor 3: Full Name
Your answer
Advisor 3: Contact
Your answer
Advisor 4: Full Name
Your answer
Advisor 4: Contact
Your answer
Advisor 5: Full Name
Your answer
Advisor 5: Contact
Your answer
Advisor 6: Full Name
Your answer
Advisor 6: Contact
Your answer
GIN PROJECT TEAMS: # of Teams and Students
Teams of Students: Each school may send up to 5 teams of students composed of between 2-6 students per team. We may consider expanding team numbers to 6 teams upon request and after we have finalized projections of registration numbers from all respective and interested schools in the region.

Students must be in Grades 7-12. If you're interested in sending more than 6 teams, please contact the GIN Conference Coordinator for more information.

TOTAL # of PARTICIPANTS: What is the total number of participants you are registering? Please include both students and advisors in this total number. *
This includes students and advisors planning to attend the conference.
Your answer
How many teams are you registering? *
Remember that each team can have up to six students.
Dietary, Medical & Accessibility Considerations
Dietary Restrictions *
Please list the number of participants and the kind of dietary restriction. Ex: Vegan: 2, Vegetarian: 3, Pescatarian 4, Lactose intolerant: 5, Nut Allergy: 6, Celiac: 7, Wheat: 8 etc.
Your answer
Medical Conditions *
Please specify if there is a participant who has a medical condition that we should be aware of. Please make sure to include any medications that we should have on hand in case of emergency. You may also include symptoms and signs that may not be common knowledge that we should keep an eye out for. Please make sure that the student brings their medication.
Your answer
Accessibility Needs *
Please specify if there is a participant who will need physical accommodations (access to ramps or alternative exits etc.).
Your answer
Flight Details
Please provide us with your flight information.
Please share a copy of your flight itinerary to include airline + flight #, arrival and departure dates and times.
Your answer
Arrival: Date, Time and Flight #
Please share airline + flight #, arrival dates and times
Your answer
Departure: Date, Time and Flight #
Please share airline + flight #, departure dates and times
Your answer
Pre & Post Conference Excursions
Pre or Post Conference Excursions
Please share your plans and dates for either your pre or post conference excursions if applicable.
Your answer
Payment Methods
Payment Method *
Check, wire transfer, cash?
Your answer
Media Release
Media Release Form: Ask GIN Staff to send you your GIN Conference Media Release Form
Media Release Form Permission *
If there is a student traveling with you who cannot release their image for safety and security reasons, please contact the GIN Conference organizers to make arrangements. See below if there are students who are not permitted to consent
Required
Please list the students full names below who are not permitted to consent to the media release
Please note that we will ask you to bring students who are not permitted to consent to the media release to the registration table on the first day of the conference to ensure that these wishes are followed.
Your answer
GIN Project Team Workshop Submissions: Please follow the instructions below carefully.
PLEASE MAKE SURE YOU FULLY ANSWER ALL WORKSHOP AND PROJECT RELATED QUESTIONS AND SUBMIT ALL REQUESTED FINAL PRODUCTS. We need your help taking our programming to the next level. Please encourage your students to start working on all the necessary registration steps ASAP (Essential question, impact statement, film festival submission, workshop lesson plan and video).

ONLY FILL OUT THE INFORMATION FOR THE TEAMS YOU ARE BRINGING. If you have one team, please fill out the information for Team 1. If you have two teams, please fill out the information for Team 1 and Team 2, etc.

TEAM 1 Information
Team #1's Workshop Title *
Your answer
Team #1's What global issue(s) does your project address? *
Your answer
Team #1's Essential question: What is the overarching question that you will answer during your workshop?
Your answer
Team #1's Impact Statement
Ex: We have successfully served _________________ amount of people by _________________ date using _________________ resources, _________________ strategies, and _________________ methods to accomplish our goal of effectively organizing _________________ community. (Please note, impact statements will vary by project, but should include who or what you are impacting, resources used, strategies, project dates and when possible quantitative measurement of your impact)
Your answer
Team #1's Project Description: 250 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #1's Plan for sustainability: How will your team work to make your project sustainable (people power, materials, lasting impact)? What steps will you take to include more community members and encourage students at your school to join your team? Share your next steps to grow your project for the following year: 300 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #1's Workshop Lesson Plan Submission
As a team (1) a description of your project (no more than 200 words), (2) your learning goals for your workshop (this may be effective strategies you used to make change in your local community that you would like to share, new findings on the issue and how you utilized these findings to make your project more effective, new ways of thinking about an old problem, etc. put your teacher hat on), and (3) include a view only link to your slideshow/keynote/prezi/etc.
Your answer
Team #1's Workshop Presentation Video
(1) Gather your team and (2) film your workshop presentation. (3) Upload your workshop video submission to youtube then (4) Name your film: Project Name, School, Year (5) click the share option and (6) copy paste the url below. (6) Make sure to tag your video with your full school name, your workshop name, Global Issues Network, and GIN Conference.
Your answer
Team #1's Workshop Film Festival Submission
(1) Upload your film festival submission to youtube then (2) Name your film: Project Name, School, Year (3) click the share option and (4) copy paste the url below. (5) Make sure to tag your video with the year, your full school name, your workshop name, Global Issues Network, and GIN Conference Film Festival. **CHECK OUT GUIDELINES FOR A GOOD GIN VIDEO** http://globalissuesnetwork.org/film-festival-guidelines/
Your answer
Student 1
1. Student Name *
Your answer
1. Student Email *
Your answer
1. Grade Level *
Student 2
2. Student Name *
Your answer
2. Student Email *
Your answer
2. Grade Level *
Student 3
3. Student Name
Your answer
3. Student Email
Your answer
3. Grade Level
Student 4
4. Student Name
Your answer
4. Student Email
Your answer
4. Grade Level
Student 5
5. Student Name
Your answer
5. Student Email
Your answer
5. Grade Level
Student 6
6. Student Name
Your answer
6. Student Email
Your answer
6. Grade Level
TEAM 2
Team #2's Workshop Title
Your answer
Team #2's What global issue(s) does your project address?
Your answer
Team #2's Essential question: What is the overarching question that you will answer during your workshop?
Your answer
Team #2's Impact Statement
Ex: We have successfully served _________________ amount of people by _________________ date using _________________ resources, _________________ strategies, and _________________ methods to accomplish our goal of effectively organizing _________________ community. (Please note, impact statements will vary by project, but should include who or what you are impacting, resources used, strategies, project dates and when possible quantitative measurement of your impact)
Your answer
Team #2's Project Description: 250 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #2's Plan for sustainability: How will your team work to make your project sustainable (people power, materials, lasting impact)? What steps will you take to include more community members and encourage students at your school to join your team? Share your next steps to grow your project for the following year: 300 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #2's Workshop Lesson Plan Submission
As a team (1) a description of your project (no more than 200 words), (2) your learning goals for your workshop (this may be effective strategies you used to make change in your local community that you would like to share, new findings on the issue and how you utilized these findings to make your project more effective, new ways of thinking about an old problem, etc. put your teacher hat on), and (3) include a view only link to your slideshow/keynote/prezi/etc.
Your answer
Team #2's Workshop Presentation Video
(1) Gather your team and (2) film your workshop presentation. (3) Upload your workshop video submission to youtube then (4) Name your film: Project Name, School, Year (5) click the share option and (6) copy paste the url below. (6) Make sure to tag your video with your full school name, your workshop name, Global Issues Network, and GIN Conference.
Your answer
Team #2's Workshop Film Festival Submission
(1) Upload your film festival submission to youtube then (2) Name your film: Project Name, School, Year (3) click the share option and (4) copy paste the url below. (5) Make sure to tag your video with the year, your full school name, your workshop name, Global Issues Network, and GIN Conference Film Festival. **CHECK OUT GUIDELINES FOR A GOOD GIN VIDEO** http://globalissuesnetwork.org/film-festival-guidelines/
Your answer
Student 1
1. Student Name
Your answer
1. Student Email
Your answer
1. Grade Level
Student 2
2. Student Name
Your answer
2. Student Email
Your answer
2. Grade Level
Student 3
3. Student Name
Your answer
3. Student Email
Your answer
3. Grade Level
Student 4
4. Student Name
Your answer
4. Student Email
Your answer
4. Grade Level
Student 5
5. Student Name
Your answer
5. Student Email
Your answer
5. Grade Level
Student 6
6. Student Name
Your answer
6. Student Email
Your answer
6. Grade Level
TEAM 3
Team #3's Workshop Title
Your answer
Team #3's What global issue(s) does your project address?
Your answer
Team #3's Essential question: What is the overarching question that you will answer during your workshop?
Your answer
Team #3's Impact Statement
Ex: We have successfully served _________________ amount of people by _________________ date using _________________ resources, _________________ strategies, and _________________ methods to accomplish our goal of effectively organizing _________________ community. (Please note, impact statements will vary by project, but should include who or what you are impacting, resources used, strategies, project dates and when possible quantitative measurement of your impact)
Your answer
Team #3's Project Description: 250 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #3's Plan for sustainability: How will your team work to make your project sustainable (people power, materials, lasting impact)? What steps will you take to include more community members and encourage students at your school to join your team? Share your next steps to grow your project for the following year: 300 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #3's Workshop Lesson Plan Submission
As a team (1) a description of your project (no more than 200 words), (2) your learning goals for your workshop (this may be effective strategies you used to make change in your local community that you would like to share, new findings on the issue and how you utilized these findings to make your project more effective, new ways of thinking about an old problem, etc. put your teacher hat on), and (3) include a view only link to your slideshow/keynote/prezi/etc.
Your answer
Team #3's Workshop Presentation Video
(1) Gather your team and (2) film your workshop presentation. (3) Upload your workshop video submission to youtube then (4) Name your film: Project Name, School, Year (5) click the share option and (6) copy paste the url below. (6) Make sure to tag your video with your full school name, your workshop name, Global Issues Network, and GIN Conference.
Your answer
Team #3's Workshop Film Festival Submission
(1) Upload your film festival submission to youtube then (2) Name your film: Project Name, School, Year (3) click the share option and (4) copy paste the url below. (5) Make sure to tag your video with the year, your full school name, your workshop name, Global Issues Network, and GIN Conference Film Festival. **CHECK OUT GUIDELINES FOR A GOOD GIN VIDEO** http://globalissuesnetwork.org/film-festival-guidelines/
Your answer
Student 1
1. Student Name
Your answer
1. Student Email
Your answer
1. Grade Level
Student 2
2. Student Name
Your answer
2. Student Email
Your answer
2. Grade Level
Student 3
3. Student Name
Your answer
3. Student Email
Your answer
3. Grade Level
Student 4
4. Student Name
Your answer
4. Student Email
Your answer
4. Grade Level
Student 5
5. Student Name
Your answer
5. Student Email
Your answer
5. Grade Level
Student 6
6. Student Name
Your answer
6. Student Email
Your answer
6. Grade Level
TEAM 4
Team #4's Workshop Title
Your answer
Team #4's What global issue(s) does your project address?
Your answer
Team #4's Essential question: What is the overarching question that you will answer during your workshop?
Your answer
Team #4's Impact Statement:
Ex: We have successfully served _________________ amount of people by _________________ date using _________________ resources, _________________ strategies, and _________________ methods to accomplish our goal of effectively organizing _________________ community. (Please note, impact statements will vary by project, but should include who or what you are impacting, resources used, strategies, project dates and when possible quantitative measurement of your impact)
Your answer
Team #4's Project Description: 250 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #4's Plan for sustainability: How will your team work to make your project sustainable (people power, materials, lasting impact)? What steps will you take to include more community members and encourage students at your school to join your team? Share your next steps to grow your project for the following year: 300 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #4's Workshop Lesson Plan Submission
As a team (1) a description of your project (no more than 200 words), (2) your learning goals for your workshop (this may be effective strategies you used to make change in your local community that you would like to share, new findings on the issue and how you utilized these findings to make your project more effective, new ways of thinking about an old problem, etc. put your teacher hat on), and (3) include a view only link to your slideshow/keynote/prezi/etc.
Your answer
Team #4's Workshop Presentation Video
(1) Gather your team and (2) film your workshop presentation. (3) Upload your workshop video submission to youtube then (4) Name your film: Project Name, School, Year (5) click the share option and (6) copy paste the url below. (6) Make sure to tag your video with your full school name, your workshop name, Global Issues Network, and GIN Conference.
Your answer
Team #4's Workshop Film Festival Submission
(1) Upload your film festival submission to youtube then (2) Name your film: Project Name, School, Year (3) click the share option and (4) copy paste the url below. (5) Make sure to tag your video with the year, your full school name, your workshop name, Global Issues Network, and GIN Conference Film Festival. **CHECK OUT GUIDELINES FOR A GOOD GIN VIDEO** http://globalissuesnetwork.org/film-festival-guidelines/
Your answer
Student 1
1. Student Name
Your answer
1. Student Email
Your answer
1. Grade Level
Student 2
2. Student Name
Your answer
2. Student Email
Your answer
2. Grade Level
Student 3
3. Student Name
Your answer
3. Student Email
Your answer
3. Grade Level
Student 4
4. Student Name
Your answer
4. Student Email
Your answer
4. Grade Level
Student 5
5. Student Name
Your answer
5. Student Email
Your answer
5. Grade Level
Student 6
6. Student Name
Your answer
6. Student Email
Your answer
6. Grade Level
Team 5
Team #5's Workshop Title
Your answer
Team #5 What global issue(s) does your project address?
Your answer
Team #5's Essential Question: What is the overarching question that you want to answer during your workshop?
Your answer
Team #5's Impact Statement
Ex: We have successfully served _________________ amount of people by _________________ date using _________________ resources, _________________ strategies, and _________________ methods to accomplish our goal of effectively organizing _________________ community. (Please note, impact statements will vary by project, but should include who or what you are impacting, resources used, strategies, project dates and when possible quantitative measurement of your impact)
Your answer
Team #5's Project Description: 250 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #5's Plan for sustainability: How will your team work to make your project sustainable (people power, materials, lasting impact)? What steps will you take to include more community members and encourage students at your school to join your team? Share your next steps to grow your project for the following year: 300 Words Max
Share your project goals, success, challenges and needs.
Your answer
Team #5's Workshop Lesson Plan Submission
As a team (1) a description of your project (no more than 200 words), (2) your learning goals for your workshop (this may be effective strategies you used to make change in your local community that you would like to share, new findings on the issue and how you utilized these findings to make your project more effective, new ways of thinking about an old problem, etc. put your teacher hat on), and (3) include a view only link to your slideshow/keynote/prezi/etc.
Your answer
Team #5's Workshop Presentation Video
(1) Gather your team and (2) film your workshop presentation. (3) Upload your workshop video submission to youtube then (4) Name your film: Project Name, School, Year (5) click the share option and (6) copy paste the url below. (6) Make sure to tag your video with your full school name, your workshop name, Global Issues Network, and GIN Conference.
Your answer
Team #5's Workshop Film Festival Submission
(1) Upload your film festival submission to youtube then (2) Name your film: Project Name, School, Year (3) click the share option and (4) copy paste the url below. (5) Make sure to tag your video with the year, your full school name, your workshop name, Global Issues Network, and GIN Conference Film Festival. **CHECK OUT GUIDELINES FOR A GOOD GIN VIDEO** http://globalissuesnetwork.org/film-festival-guidelines/
Your answer
Student 1
1. Student Name
Your answer
1. Student Email
Your answer
Gradel Level
Student 2
2 Student Name
Your answer
2 Student Email
Your answer
Grade Level
Student 3
3 Student Name
Your answer
3 Student Email
Your answer
Grade Level
Student 4
4 Student Name
Your answer
4 Student Email
Your answer
Grade Level
Student 5
5 Student Name
Your answer
5 Student Email
Your answer
Grade Level
Student 6
6 Student Name
Your answer
6 Student Email
Your answer
Grade Level
GIN TEAMS APPLY TO KEYNOTE
If your team would like to participate as a keynote presenter (10 minutes) please answer yes to this question. And answer the following questions. If not please mark the no option and answer the following questions with NA.
What is your GIN Project Team Name
Your answer
Why do you feel that it is important for your team to address the whole GIN Conference audience?
Your answer
A copy of your responses will be emailed to the address you provided.
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