Global Next - Application

Application

Choose Your Leadership Conference:

	"The Laws of Legacy" - Leadership that Lasts St. Antony's College, Oxford University, UK $1450 plus airfare 09/09/2010 to 09/15/2010		"Who Let the Dogs Out?" - Understanding Yourself and Others Rome, Italy $1250 plus airfare 11/04/2010 to 11/10/2010
	"Echoes of Your Life" - Leadership and Relationships Germany/Austria $1375 plus airfare 11/12/2010 to 11/18/2010		"Holocaust Studies" - Leadership Lessons From Horror Krakow, Poland $1250, plus airfare 01/20/2011 to 01/26/2011
	"The Communication Puzzle" - Becoming a Communicator of Purpose Paris, France $1375, plus airfare 03/02/2011 to 03/08/2011		"Connecting the Dots" - Understanding Your Culture Greece $1325 plus airfare 03/13/2011 to 03/19/2011
	"The Middle East Effect" - The Illusive Pursuit of Peace and Truth (CCA) Israel $1375 plus airfare 04/09/2011 to 04/17/2011		"How to Build a Life" - Intelligent Life Strategies Cairo, Egypt: The American University of Cairo $1250 plus airfare 06/07/2011 to 06/15/2011
	"The Middle East Effect" - The Illusive Pursuit of Peace and Truth Israel $1375 plus airfare 06/16/2011 to 06/24/2011

Traveler Information

Last Name:
First:		Middle:
Street Address:
City:		State:
Zip:
Home Phone:		Work Phone:
Email Address:
Date of Birth:		Male: Female:
Student Traveler Parent Chaperone Faculty Chaperone Adult Traveler

Parent(s)
Parent:
Email Address:

Sponsoring School Information
Sponsoring School or Organization:
City:
Contact Person:
If you are part of a group traveling together, please provide the email address of your group leader or contact person:

Health Information
Medication taken (if any):
Known health problems:
Emergency Contact Person:
Emergency Phone Number:

Release Information: Must be signed in order to participate in any Global Next LLC event or activity. By finalizing the registration form and passing the validation of the online form, I confirm that I agree to the following.

I have read and agree with the terms of Global Next LLC's trip and payment policies.
I have read and agree to the traveler's pledge.
I have read and agree with Global Next LLC's release of liability terms.
I give Global Next LLC and its representatives permission to use photographs, videos, and any others physical likeness of myself and/or my child traveler(s) in their publications and organizational materials.
I have my school administrator's permission to participate in this international conference.

Parant/Guardian:

Date:

Traveler:

Date:

Release of liability information:

Parent's Initials

I, as the legal guardian of the student listed on the above application, or as an adult traveler listed on the above application hereby give my express permission for my child or myself to participate in the above international conference with Global Next LLC.

In the event there arises an emergency, necessitating medical or surgical attention, I hereby consent and give my permission to the staff of Global Next LLC, individual sponsors, or any attending physician to make such decision and to perform such medical treatments and/or surgery upon said minor or myself which may in their sole discretion be necessary and proper under the circumstances.

I, the undersigned parent and/or guardian of a minor, or adult traveler, do release, acquit, discharge, and covenant to hold harmless Global Next LLC its employees, and sponsors from any and all actions, damages, and liabilities arising out of the treatment of any sickness or accident, incurred by my said child or myself during the above marked dates while attending the above dated leadership conference and associated activities.

I understand and hereby agree to assume all of the risks that may be encountered with my child's or my participation, in the above named Global Next LLC International Leadership Conference, including activities preliminary and subsequent hereto, transportation to and from the above destination, and emergency medical treatment of my child or myself during said international conference.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE, WAIVER AND INDEMNITY AGREEMENT, KNOW THE CONTENTS THEREOF AND I SIGN THIS DOCUTMENT AS MY OWN FREE ACT. This is a legally binding agreement that I have read and understand.

Please give us your full, legal name as it shows on your passport, (or driver's license, government or school issued ID for domestic trips.) Applications must be accompanied by a $250, non-refundable deposit. If you have any questions, make sure you check with a Global Next LLC regarding policies, fees, and optional trip cancellation insurance. If taking an international trip, be sure to have your passport no later than 45 days prior to your trip.

Make all checks payable to: Global Next. Please mail all applications and checks to:
Global Next: International Leadership Institute
PO Box 2215, Frisco, TX 75034

Application

Choose Your Leadership Conference:

Traveler Information

Parent(s)

Sponsoring School Information

Health Information

Release Information: Must be signed in order to participate in any Global Next LLC event or activity. By finalizing the registration form and passing the validation of the online form, I confirm that I agree to the following.

Release of liability information: