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GIFT Presenter Registration
How did you hear about the Global Innovation Field Trip?
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Facebook
Twitter
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Friend or Colleague
Conference or Trade Show
Other
Full Name of Person Completing Form:
(Required)
The GIFT presenter can be any age, but the person completing this form must be 18 years old or older
Person Completing Form Is:
(Required)
Parent/Guardian
Teacher
Program Leader
Presenter who is 18 years old or older
Email Address of Person Completing Form
(Required)
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Phone Number of Person Completing Form
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Individual or Team Presentation?
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Individual Presentation
Team Presentation
Total Number of Presenters (if more than 10 complete a second form)
(Required)
2
3
4
5
6
7
8
9
10
Presenter's Full Name
(Required)
This Presenter is:
(Required)
Under 18
18 or Older
Organization Name (If Applicable)
Country
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State, Province, Territory, Prefecture, Republic or Region
(Required)
Grade or School Level (or equivalent) - If Applicable
Email Address (Parent's if under 18)
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Enter Email
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Presenter 2
Presenter 2 Full Name
(Required)
Presenter 2 Country
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Presenter 2 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 2 Grade Level (or equivalent) - If Applicable
Presenter 2 Organization Name (If Applicable)
Presenter 2 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presenter 3
Presenter 3 Full Name
(Required)
Presenter 3 Country
(Required)
Presenter 3 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 3 Grade or School Level (or equivalent) - If Applicable
Presenter 3 Organization Name (If Applicable)
Presenter 3 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presenter 4
Presenter 4 Full Name
(Required)
Presenter 4 Country
(Required)
Presenter 4 State, Province, Territory, Prefecture, Republic or Region
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Presenter 4 Grade or School Level (or equivalent) - If Applicable
Presenter 4 Organization Name (If Applicable)
Presenter 4 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presenter 5
Presenter 5 Full Name
(Required)
Presenter 5 Country
(Required)
Presenter 5 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 5 Grade or School Level (or equivalent) - If Applicable
Presenter 5 Organization Name (If Applicable)
Presenter 5 Email Address (Parent's if under 18)
Enter Email
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Presenter 6
Presenter 6 Full Name
(Required)
Presenter 6 Country
(Required)
Presenter 6 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 6 Grade or School Level (or equivalent) - If Applicable
Presenter 6 Organization Name (If Applicable)
Presenter 6 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presenter 7
Presenter 7 Full Name
(Required)
Presenter 7 Country
(Required)
Presenter 7 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 7 Grade or School Level (or equivalent) - If Applicable
Presenter 7 Organization Name (If Applicable)
Presenter 7 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presenter 8
Presenter 8 Full Name
(Required)
Presenter 8 Country
(Required)
Presenter 8 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 8 Grade or School Level (or equivalent) - If Applicable
Presenter 8 Organization Name (If Applicable)
Presenter 8 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presenter 9
Presenter 9 Full Name
(Required)
Presenter 9 Country
(Required)
Presenter 9 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter 9 Grade or School Level (or equivalent) - If Applicable
Presenter 9 Organization Name (If Applicable)
Presenter 9 Email Address (Parent's if under 18)
Enter Email
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Presenter 10
Presenter 10 Full Name
(Required)
Presenter 10 Country
(Required)
Presenter 10 State, Province, Territory, Prefecture, Republic or Region
(Required)
Presenter Grade or School Level (or equivalent) - If Applicable
Presenter 10 Organization Name (If Applicable)
Presenter 10 Email Address (Parent's if under 18)
(Required)
Enter Email
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Presentation Information
What would you like people to know about you? (50 word limit)
(Required)
Title of Presentation (50 character limit)
(Required)
Short Description of Presentation. (300 character limit)
(Required)
Would you be interested in a 10 or 25 minute presentation session? (We will try to accommodate your request, but there are no guarantees.)
(Required)
10 Minute Presentation
25 Minute Presentation
Longer than 25 minutes (you will be contacted for more information)
Time Zone (of person completing this form)
(Required)
Indicate what time of day in your time zone you would like to present (Select ALL that you are available).
(Required)
Pre-Dawn (1AM - 7AM)
Morning (7AM - 12PM Noon)
Afternoon (12PM Noon - 5PM)
Evening (5PM - 9PM)
Night (9PM - 1AM)
Select All
By completing this registration and/or participating in this event, you agree to the following Photographs and Media CONSENT:
(Required)
I agree to the privacy policy.
Consent Form