Personal Information

* E-mail

* Group

* First name (as it appears on passport)

* Last name (as it appears on passport)

* First name as you would like on nametag

* City (where you currently live)

* Country

* Mailing address

* Emergency contact name

* Emergency contact phone number

T-Shirt Size (adult unisex)

* Roommate- select one:

I would like a roommate

I want a single room for additional $975 USD per person. - You will be responsible to cover the additional cost for a single room.

Rooms are double occupancy, there is an additional fee of $975 USD if you desire a single room. This fee is at your expense and single rooms are not guaranteed.

Name of preferred roommate:

Language Assistance- If you are in need of language assistance, we will be offering translation into French and Spanish. Please select which translation you will need.

French

Spanish

Passport Information

Full name (as it appears on passport)

Passport number

Passport date of issue

Passport expiration date

Your passport needs to be valid for six months from your arrival into Turkey. Expiration should be after September 13, 2023.

Passport issued from which country

Place of birth (as listed on your passport)

* Nationality

Date of birth

Visa Information

Note: Please check with the Turkish consulate to determine which type of visa you will need. If you need a letter from Concentric and our tour guide, you should let us know. Begin the Visa process as soon as possible. E-visas can be completed online - https://www.evisa.gov.tr

Visa information - select one:

I do not need a visa in advance.

I need a visa and am working on getting one.

I have received my visa for this trip.

Flight Information

You must arrive in Izmir, Turkey on Monday, March 13 no later than 5 p.m. (if possible). Hotel shuttles will be grouped by arrival times. We will end the Summit on Monday, March 20, and you may depart from Izmir anytime after 8 a.m. on the 20th.

Date of arrival in Izmir

Airline and flight number into Izmir

Flight arrival time into Izmir

Date of departure from Izmir

You may depart after 8 a.m. on Monday, March 20, 2023.

Departure time from Izmir airport (be sure to include a.m. or p.m.)

My Commitment

As I am receiving a grant scholarship for my participation in the Concentric Summit, I commit to communicate in a timely manner, complete all preparation materials, attend the entire Summit and actively engage with Summit participants when on-site.

* I agree to the My Commitment above.

Waiver of Responsibility

I will hold Concentric blameless in the event of cancellation or changes in travel and program schedule. I release Concentric from claims of any nature incurred by me before, during, or after my time in Turkey, and from claims arising from any act involving any person, agent or entity not part of the Concentric Summit. I agree that, in the event of any war (declared or undeclared), strike, terrorism, act of God, or emergency not under the control of Concentric, I will not hold Concentric liable.

* I have read this Waiver of Responsibility, understand its content, and accept the risks discussed.

Travel Insurance

Travel insurance is highly encouraged for this trip. Volunteer Card will insure anyone on international travel no matter country of origin. They offer a one year insurance for $67 USD that covers all international travel or a one-time trip coverage at $30 USD. You must purchase this coverage at least 24 hours before departure. It is not applicable if you have already begun to travel. People outside of the USA will need to call to make payment over the phone, but this coverage is available to international persons. You will need to sign up and pay for this individually. https://www.volunteercard.com

Health and Medical Information

* Medical Training

Please list any medical certifications you have, for example first aid, CPR, AED: (if you don't have any medical training, list "none").

* Health Concerns

Please list any surgery, hospitalization or emergency room visit(s) in the last 6 months: (if you have not experienced any health issues in the last 6 months, list "none").

* Allergies

Please list any allergies you have, whether they are life threatening, and if you have had any serious allergic reactions in the last 6 months: (if you have no allergies, please list "none").

Health Statement

I acknowledge that I am in good health and I absolve Concentric from any medical or health issues that arise during or after this trip. If in the days prior to the Summit, I have any signs/symptoms of COVID, I will take necessary precautions. If I test positive for COVID, I agree to not travel to the Summit.

* I agree to the Health Statement above.

Yes, you can use my personal data for these purposes

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2023 Concentric Summit - Turkey