LACR Leadership Summit 2019 - Student Application

Latin America & the Caribbean Leadership Summit 2019 - Student Application
30 August - 1 September 2019
Buenos Aires, Argentina
After submitting the form you will receive a link to your email address allowing you to edit your responses in case you are unable to complete the entire form at once. Remember the deadline to submit registration and to complete and submit the form is Friday, April 26.
Email address*
First Name/Given Name*
Please write your first/given name as it would appear on your travel documents (visa/passport).
Middle Name/Second Given Name*
Please write your middle name as it would appear on your travel documents (visa/passport). Write n/a if not applicable.
Last Name/Family Name*
Please write your last name/family name as it would appear on your travel documents (visa/passport).
Second Last Name/Family Name*
Please write your second last name/family name as it would appear on your travel documents (visa/passport). Write n/a if not applicable.
City*
State*
Country*

SECTION 1: UNIVERSITY INFORMATION
University Name*
University City*
University State*
University Country*
Faculty Contact - Name*
Please include the name of a faculty member who can speak to your performance at school.
Faculty Contact - Email*
Please include the email address of the faculty member who can speak to your performance at school.

SECTION 2: EDUCATIONAL INFORMATION
Current Field of Study (Major)*
Concentration or Special Interest
Classification of Study*
UndergraduateGraduatePh.DOther
Semester/year of Study*
Please enter the semester/year you are in.
Graduation Date - Year*
Please enter the year in which you will graduate (expected).

SECTION 3: AAPG INVOLVEMENT
Are you a member of AAPG?*
YesNo
If yes, please list your AAPG identification number
Are you a member of a AAPG Student Chapter?
YesNo
If yes, what is the name of your Chapter?
Are you a AAPG Student Chapter Officer?
YesNo
Have you previously participated in a program/talk/event/congress held by AAPG?
YesNo
If yes, please list where and the date.

SECTION 4: QUESTIONS
Describe your involvement with AAPG and your chapter.*
Answer lenght: 500 characters maximum.
What are your career goals and expectations after graduation? *
Answer lenght: 500 characters maximum.
How will participating in LACR Leadership Summit 2019 help you reach your career goals? *
Answer lenght: 500 characters maximum.
Video: Why would you like to attend LACR Leadership Summit 2019? Tell us with your own words.*
Please record and send a short video (maximum 2 minutes long) to lacevents@aapg.org, daiane.cardoso.geo@gmail.com, and lpcalizaya@gmail.com with the subject: "Video [Your Name] LACR Leadership Summit". It MUST be recorded in English –don't worry about your English skills–. Check the box to certify that the video file has been sent/will be sent soon. Note: If the file is not sent by the deadline, your application will not be considered.

SECTION 5: AGREEMENT
Please check the boxes if you agree.*
I commit to attending the entire event on 30 August - 1 September.
TERMS OF ACCEPTANCE AND SIGNATURE
I, the applicant, warrant the truthfulness of the information provided in this form.
Electronic Signature*
Please type your First and Last Name
I understand that checking this box constitutes a signature confirming that I acknowledge the above Agreement.
Done!
Remember to save the link that you will receive to your email address after submitting the form. It will let you edit your responses until the deadline, Friday, April 26, in case you were unable to complete all the questions at once.
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Latin America & the Caribbean Leadership Summit 2019 - Student Application