Social Innovation Weekend Student Registration

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Thank you for your interest in attending Social Innovation Weekend 2021 hosted March 5-7, 2021. This event registration should take 5-10 minutes to complete. For further information visit socialinnovationweekend.com. If you have any questions, contact Madelyn Harvey, Head Student Organizer, at harveym5@miamioh.edu or Katie Stautberg, Participant Recruitment Lead, at stautbkr@miamioh.edu.

Email *

First Name *

Last Name *

Cell Phone Number *

URL Link to LinkedIn profile

Shipping Address *

Please select the college or colleges your major is in: *

College of Arts and Sciences

College of Creative Arts

College of Education, Health, and Society

College of Engineering and Computing

Farmer School of Business

Required

Major(s) *

Minor(s) *

Graduation Year *

Have you participated in Social Innovation Weekend before? *

Yes, more than once!

Yes, once!

No, this will be my first one!

Have you participated in Start-Up Weekend before? *

Yes, more than once!

Yes, once!

No, this will be my first one!

Any restrictions we should be aware of for your virtual attendance (ex. Webcam issues, spotty wifi, etc)? *

Would you like to receive a SIW care package (must be able to pick it up on Miami University - Oxford's campus during the week of March 1-7, 2021)? *

Yes, I will be in Oxford during that week.

No, I am not interested or will not be in Oxford during that week.

What time zone will you be in while attending the weekend virtually? *

EST

CST

PST

Other

Consent Form

I, the undersigned, expressly accept and agree to the following terms and conditions of this Release Agreement to participate in Social Innovation Weekend Miami-virtual. I agree to release, waive and relinquish any and all claims I may have, as a result of my participation in the Program, against Miami Releasees.I do hereby fully release and discharge Miami Releasees from any and all claims from injuries, damages or loss which may have or which may accrue to me on account of my participation in the Program. I further agree to indemnify, defend and hold harmless Miami Releasees, Miami, its mentors, its students, and/or family members from any and all claims resulting from injuries, damages and losses sustained by me arising out of, connected with, or in any way associated with the activities of the Program. I have read fully and fully understand this release form. By signing this form I grant permission to be photographed, recorded, or videotaped for Miami promotional materials. I understand that this photograph, speech, or video may appear in various publications or marketing and media outlets. I also give permission for this material to appear on the Miami social media pages and website. I understand that this material may appear on television or other media for related promotional purposes, as well as in print or online for partner organizations.

Please type your full legal name for the signature. *

Please indicate the date of your signature. *

YYYY

Don't forget to register for ESP 102 or GHS 301! Check out our website socialinnovationweekend.com for details on how to register! *

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