Please confirm which track you're registering for
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Track 1 & 2 (Friday & Saturday): Full 2 Day Experience
Track 1 Only (Friday, June 26): Coffee Chat with Founders
Track 2 Only (Saturday, June 27): Founder Finance & Investor Readiness Lab
Participant's Name
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First Name
Last Name
Participant's Date of Birth
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-
Month
-
Day
Year
Date
Participant's Gender
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Female
Male
Which College/University are you attending?
*
Participant's Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Participant's Email
*
example@example.com
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you looking for an internship?
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Yes
No
Do you have a startup?
Yes
No
What is the name of your startup?
*
Please describe your startup in one sentence
*
Parent/Guardian Information (For minors)
Mother's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Name
*
First Name
Last Name
Mother's Email
*
example@example.com
Father's Name
*
First Name
Last Name
Father's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Email
*
example@example.com
Does the participant have any allergies?
*
Media Release
BEAM Venture Institute has my permission to use my or my child’s photograph publicly to promote BEAM Venture Institute. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensations shall become payable to me by reason of such use.
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Participant's Signature (Parent if minor under 18)
Waiver and Release of Liability
I agree that this Waiver and Release of Liability shall apply to each day my child attend's this conference regardless of the date that this form is signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises where the conference is being held ; and to the maximum extent of the law, I agree to waive and release any and all claims, suits, or related causes of action against BEAM Venture Institute, their owners, officers, employees or agents for injury, loss, death, costs, or other damages to me, my heirs or assigns, or third party claims suits or related causes of action asserted against BEAM Venture Institute programs or activities arising from my conduct and/or family’s conduct while participating in BEAM’s programs and activities. I further agree to release, indemnify, defend and hold BEAM Venture Institute harmless from any liability whatsoever for future claims presented by my child for injuries, losses, or damages.
*
Participant's Signature (Parent if minor under 18)
Support the BEAM Venture Programs
Please consider supporting our mission with a donation today. By donating to BEAM Venture Programs, you're investing in the potential of our youth and ensuring that our programs remain free and accessible to all. Your generosity enables us to continue inspiring and empowering young Muslim leaders while keeping our programs and events free of charge.
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