WMAN Conference 2016 Application Form November 17-19, 2016
Apache Gold Resort and Casino San Carlos, Arizona
[Note: Everyone wanting to attend the WMAN 2016 Conference must apply, regardless of whether scholarship assistance to cover travel and/or on-site costs is needed, as we must manage our space as well as cost logistics. However, we will accept as many applicants as possible. If you have any questions while filing out this form, contact WMAN Coordinator Mary Costello at (208) 610-4896 or [email protected]
Between a Rock and a Hard Place: Protecting Water, Traditional Cultures, and Landscapes in a Changing Climate
Application Due by Aug. 31, 2016 Decisions will be made by September 30, 2016
Please Complete One Form for Each Person Applying
*Please note that late applications will be accepted, but we cannot guarantee space, accommodations, or support for travel and on-site costs.
Name (please print or type):
Organization (if any):
Tribal or First Nations Affiliation (if any):
Mailing Address:
E-mail Address:
Web Site (if any):
Telephone Number(s): home: cell:
Fax # (if any):
1Application for WMAN 2016 Conference, November 17-19 Would you like your, or your organization’s, contact information to be listed on WMAN’s public database (available online http://wman-info.org/participants/)? If so, please say “yes” here:
Please answer the following questions: 1. Please describe, in brief, the mining issues on which your organization is working.
2. Please explain, in brief, why you would like to attend this conference and how it might support your organization and/or your participation in mining-related work.
3. Travel: ____ I am able to cover my own travel.
____ I require a travel scholarship. ____ I will drive. ____ I will fly.
WMAN will purchase airline tickets for scholarship participants needing to fly. Please note that if you cancel after your ticket is purchased, you are required to reimburse WMAN for the cost of your ticket as tickets are non-refundable and non-transferable.
If you are awarded a scholarship and decide to drive instead of fly, WMAN will pay up to the purchase price of a ticket at the time tickets are being booked. Mileage will be reimbursed at .40 cents a mile or the actual cost of gas (receipts must accompany requests for gas costs). Reimbursements will be processed after the meeting, upon submittal of a reimbursement form.
4. We work to raise/provide scholarship funds for the greatest number of attendees. It will cost WMAN an average of $685/person for travel expenses, shared-room lodging, food, meeting rooms, and ground transportation to and from the venue. How much, if any, beyond the $75 conference registration fee (expected of all participants), can you and/or your group put toward your travel costs and the on-site costs of $685?
5. If you are requesting scholarship assistance to cover travel costs and/or accommodations, please provide your organization’s budget amount (if you are attending for an organization) and describe why your organization needs to have your travel costs and/or accommodations covered.
2Application for WMAN 2016 Conference, November 17-19 6. The WMAN Indigenous Caucus may host a meeting and/or dinner on Thursday, November 17. Attendance may require arriving one day early if you are flying in from a remote location. We have some scholarship funding designated for indigenous participants. If you are indigenous and would like to attend, please indicate that here and state whether you are an indigenous applicant from the US or Canada. (Please also be sure to note your tribal or First Nations affiliation here and/or above in the contact information section.)
7. If you are awarded a scholarship, this scholarship may cover up to four nights of lodging. Four nights is the maximum nights of lodging that may be covered.
I will need lodging for:
____ Wednesday, Nov. 16 (To attend Thursday’s indigenous function) ____ Thursday, Nov. 17 ____ Friday, Nov. 18 ____ Saturday, Nov. 19
Rooms will be booked double occupancy (2 people per room). If you know another person applying to attend, you may tell us here with whom you’d like to share a room. If you request a single room, you, or your organization, will be required to pay the difference (approximately $40/night). Please make any needed notes here on your lodging:
Participants will be responsible for any costs associated with bringing a family member/friend with them. These expenses must be paid upfront prior to the conference. Please note that WMAN will not be providing daycare, and it is the responsibility of parents to provide for their own daycare, if it is needed.
8. Do you have any mobility special needs or other requirements of your room?
9. Do you have any special needs or dietary requirements (e.g., vegetarian, vegan, gluten- free)? We will do our best to accommodate, when possible.
10. We would like to include information on each person/organization attending in our Participant Packets. Please let us know briefly your organization’s mission (if you are coming for an organization), and what mining issues you are working on. Please limit your response to 100 words. (This saves paper when we print out conference information. We reserve the right to edit responses that are longer.)
3Application for WMAN 2016 Conference, November 17-19 Conference Fee: $75 (U.S. dollars) The registration fee is expected of all participants. Financial support for travel to the meeting and scholarships to cover food/lodging at the event are available, but we ask all participants to at least raise this registration amount.
Note: If you are selected to attend the 2016 WMAN Conference we will let you know to which address to mail your $75 registration fee and any other funds you have agreed to put toward your costs. If your airline ticket will be paid by WMAN, we will book that ticket for you.
Completed application forms may be e-mailed to [email protected].
4Application for WMAN 2016 Conference, November 17-19