BRIDGES PeaceJam involves Mid-South young people from elementary through high school in studying the art of
peace by focusing on the lives and work of Nobel Peace Laureates.

Teacher/Sponsor Registration Form

Teacher/Sponsor Mid South 2011 PeaceJam Youth Conference Registration Form

How much time is involved?

The Mid South 2011 PeaceJam Youth Conference is a two-day interactive experience at Rhodes College on Saturday, February 12, 2011, 8:00am-8:30pm and Sunday, February 13, 2011, 8:00am-3:30pm.  Registration Check-In starts at 8:00 AM and Programming begins promptly at 8:30 AM.  

How much does the 2011 Mid South PeaceJam Youth Conference cost?

Student and adult participants* pay $75 **(need based aid upon request)* for Mid South PeaceJam Youth Conference. With the Registration Fee, PeaceJammers receive a light breakfast, lunch, dinner (Sat. only), t-shirt, and program materials for the two-day Youth Conference.  As an added bonus registrant/participation in the conference allows youth participants and their Families to attend the Nobel Peace Prize Winner's Public Talk at the University of Memphis on Friday (evening of Feb. 11, 2011) before the Saturday/Sunday conference at Rhodes College. 

*With the paid PeaceJam Annual Club Fee ($150), 1 Adult participant registration for the Conference is included (additional adults fees are $75).
**To request need-based aid for specific students, please contact Andrew Taylor Peck, Director of PeaceJam at ataylorpeck@bridgesusa.org.  

 

*****PeaceJam Sponsor Contract*****

As a PeaceJam Sponsor for the PeaceJam Conference on February 12-13, 2011 in Memphis, Tennesee, I agree to the following:

  • I agree to come with a group of at least five representives from my school or organization.
  • I agree to aid my students in online registration and the collection of forms and fees for the the PeaceJam Conference.
  • I agree to remain at the conference to be accessible and supportive to my students throughout the entire two-day program.
  • I agree to be reachable via mobile phone (if possible) throughout the event.

What I will bring: GCA Project Plan Worksheet, weather appropriate/comfortable clothing,pens, pencils, notebooks, camera, mobile phone (if possible).

What I will not bring: CD/MP3/music players of anykind, glass containers, weapons/pockets knives, non-prescription drugs, alcohol.

 

**In addition to filling out the below form, you need to complete the PeaceJam Sponsor Release.  This form must be turned into at BRIDGES PeaceJam the morning of Registration (Feb. 12, 2011 @ 8:00 am) for you and your students to attend the Conference.

First Name:
Last Name:
Email Address:
Preferred Phone Number (mobile if applicable):
Home Address:
City:
State:
Zip:
Gender
Race/Ethnicity
School/Organization you attend PeaceJam with:
School/Organization Address:
City:
State:
Zip:
Do you lead a PeaceJam Group at your school/organization?
Approximately how many PeaceJam events have you attended in the past?
T-Shirt Size
Vegetarian meal needed? Due to catering restrictions, vegan and wheat free meals are not available
Other food allergies, physical accomodations, or other needs you would like us to be aware of?
By signing my name, I agree to the PeaceJam Sponsor Contract.
Please answer the simple math question below to submit the form.
2 + 2 =