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2003 Community Research Network 6th Annual Conference


"Powerful Collaborations: Building a Movement for Social Change"

OCTOBER 16-19, 2003

The Audubon Center of the North Woods
Sandstone, Minnesota

Scholarship Application and Registration Form

Due September 2, 2003

2003 CRN Info 2003 CRN Schedule 2003 CRN Proposals 2003 CRN Registration 2003 CRN Scholarship 2003 CRN HOTEL INFO

The 2003 Conference was a success, due primarily to the willingness of the attendees to take part in the participatory approach to the presentations. Check back to this web site for reports about the conference as they are posted.

Name:

Organization:

Preferred Mailing Address (Street):

City:

State: Zip:

Country:

Phone:

Fax:

Email:

Website:

How did you hear about the conference?

Please use the space below to include a brief (50 word) bio and contact info, if appropriate. This information will be used for the conference bio list unless you specify otherwise.

 

Race/Ethnicity:

(Your response is optional but we are committed to ensuring a diverse group of participants)

Gender (for room assignments):

Would you be interested in being a Notetaker for one or more of the sessions? We are looking for people who can take clear and comprehensible notes that will later be used in writing the 2003 Conference Report.

  I would like to volunteer as a Notetaker.  (Information/instructions will be provided at registration)

SCHOLARSHIP QUESTIONS:

1. Please describe your current work or interest in community participation:

2. What do you hope to learn or gain from the conference? Please describe your plans for sharing what you learn in your community:

3. Please give an example of an experience in your life that has stimulated your interest in this work and your participation in this conference:

4. Explain your need for a scholarship:

5. Please provide the name and contact information for someone who can speak to your work or interest in community issues:

Registration Fees: 

Applicants for full scholarships do not need to complete the questions directed towards partial scholarships until we have responded to your request.  If you are applying for a partial scholarship, please include a check for the Registration fee and any other expenses not requested in scholarship application.  Fee is required to secure your space.  (Non-refundable after September, 26, 2003). Remaining balance is due by September, 26, 2003.

I am applying for (check one): (please be realistic, there is a set amount in our scholarship fund, and we prefer to provide support to as many people as possible. You will receive notification of monies allocated by Sept.12)

Individuals $ 125.00
Low-Income ... $ 35.00

I will be paying by

Partial Scholarship (Please fill in amounts below. A number must be inserted into the next four boxes in order for the form to be processed. Zero (0) works in those spaces not applicable. It has to be a number though, not a letter or word.)

Travel Expenses* (you must fill out the transportation info below) amount requested:
$
Room and Board (housing and meals) amount requested: $
Child/elder care (at home) amount requested: $

Full Scholarship (travel, housing, meals, child/elder care and registration. Insert a (0) if applying for a partial scholarship.)* 
amount requested: $

*Travel expenses include flight and transportation to/from airport, or mileage. Upon acceptance, we will notify recipients of amount allotted for travel and/or child/elder care. Scholarship recipients are responsible for arranging travel. Recipients will receive reimbursement for travel and/or child/elder care after conference after receipts are submitted. Special arrangements can be discussed if prepayment of travel/care is impossible.

Accommodations and Food: On-site housing is available, but limited. All dorm-style rooms have 8 single (bunk) beds and a private bath. Pricing is for 4 or 8 persons per room.

FOOD: the in-house chef prepares wonderful meals and can accommodate some special diet needs. Packages include accommodations, linens, meals and snacks.

I want to room with:

I would consider an off-site hotel with meal package if the Audubon Center is full, or because I need one night only accommodation with meals.

Insert nights you will be staying at the Center.

I will attend the Thursday night dinner and/or reception from 7-9 PM.

Special Needs: Insert special needs regarding dietary, environmental, disability access & needs, etc.

TRANSPORTATION: The Audubon Center is located about two hours north of the Minneapolis/St. Paul (MSP) airport. Van shuttles will be available from the airport at these designated times only on a first come first served basis. YOU MUST reserve a space below. The cost will be $30/person round trip to be paid by Sept. 26. Please plan to arrive at least 45 min. before van pick-up.

Airport Pick-ups: Thursday, Oct. 16 -- 3:00 PM; 4:30 PM and 7:30 PM. Friday, Oct. 17 -- 11 AM only.

Leaving Conference: (allow 2 hour travel time + check-in) Sunday, Oct. 19 -- 11:00 AM, 12:00 Noon and 1:00 PM.

Get a 10% discount on NorthWest airlines if reserved 30 days in advance (by Sept. 16), 5% thereafter.  Call: 1.800.328.1111 WorldFile NM2ZL, 7am 7 pm CST, M F.

Note: if arriving/leaving at other than scheduled shuttle times, you are responsible for your own transportation. Driving directions are on our website. Questions or concerns? Contact Teresa Konechne (contact info below). You will receive a confirmation and shuttle pick-up site once reservation is made and fee paid.

I am arriving by: to the

  I will need van shuttle transportation ($30/person round trip paid in advance or included in scholarship) to and from the Minneapolis airport to the Audubon Center.

Arrival time and date:

Departure time and date.

Car pooling: I will have a car at the airport and could assist people with transportation needs from/to the airport

Arrival time and date:

Departure time and date.

Additional Information:

 

 

 


Space is Limited! You will be registered on a first come, first served basis.   For more information about the Audubon Center, check out their website: www.audubon-center.org.

Deadline for registration forms is Monday, September 2, 2003. Forms sent by mail need to arrive no later than September 2, and all faxed and emailed forms need to be received by 5 PM on September 2.

Confirmation sent upon receipt of registration form and payment of registration fee.

NO REFUNDS ON REGISTRATION FEES WILL BE MADE AFTER SEPTEMBER 26, 2003.

Complete on-line registration and payment (preferred), or download the RTF file (link button above), print it out, and send the completed form and check payable to the Loka Institute to:


REGISTRATION FEES: Registration fee is required in order to secure your space at the conference, unless you have requested that it be part of a scholarship. After you have filled out the registration form above, you may pay your fee by check sent in the mail, or use the secure site PayPal "Shopping Cart" to pay on-line, respective of the selection you made with the registration form. (This is non-refundable after September, 26, 2003). 
Remaining balance (room and board) is due by September, 26, 2003, as well. 

If paying for more than one person, you can add the number of people you are paying for in the new browser window, then list their names in the optional information box during payment process. First time users of PayPal's secure site will need to register with PayPal. It's a free service and only takes a few minutes.

Full Registration
$125.00
|

 

Low Income
Registration
$35.00

 

4 person room
6 meals, 2 nights
$130.00

 

4 person room
9 meals, 3 nights
$170.00

 

8 person room
6 meals, 2 nights
$100.00

 

8 person room
9 meals, 3 nights
$140.00

 

Roundtrip Airport
Van Shuttle
$30.00

 

View Your Shopping
Cart
|

 

 


 

 The Loka Institute c/o Rachel Maldonado PO BOX 6847 Austin,  TX  78762

QUESTIONS? For questions concerning registration, proposals or scholarships contact:

Rachel Maldonado -  crn2003@loka.org,  512.585.1507 (ph)    512.268.5583 (fax)

For questions concerning transportation, housing or meals contact: Teresa Konechne  -  crn2003@loka.org 612.871.2576 (FAX/phone)

You can make a voluntary contribution to help fund a scholarship with an on-line secure-site donation: Donate Now!

Thank you!!

 


The Loka Institute is grateful for financial support from the
Annie E. Casey Foundation for this conference.

Up 2003 CRN Info 2003 CRN Schedule 2003 CRN Proposals 2003 CRN Registration 2003 CRN Scholarship 2003 CRN HOTEL INFO

 

 

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This page last modified: October 14, 2004 The Loka Institute