The Ninth Annual World Jam

Required Questions: Basic Info

Complete Name (exactly as it appears on your passport, with all initials):


Nickname (what you prefer to be called):


Organization Name (if applicable):


Street Address:


City:

State/Province:	Zip/Postal Code:

Country:


Passport Number:


Passport Nationality:


Passport Expiration Date:



Phone Numbers: (please include country code, city (area)code, phone number, and any extensions)

Work Phone Number


Home Phone Number:

Pager Number (if applicable):	Cellphone Number (if applicable):

Fax Number:


Email Address:


Website of Group (if applicable):

Birthday (month/day/year):	Age:

Gender:


Ethnic Background:


Languages Spoken (please note how well you speak each language. Rate from poorly, conversational, well, extremely well, fluently):



Where and Who You Are

Share your story with us. What got you engaged in making a difference, and what are you up to now?


What is your work? What are you passionate about?


What is wrong in the world today for you?


What gives you hope?


An important aspect of the Jam is bridge-building (between movements, issues, cultural backgrounds, faiths, sexual orientations, etc.). Why is this relevant to your work and/or important to you personally at this time? How and when is bridge-building challenging for you? In what conditions has it worked well for you?


What burning questions are alive in you today?


Why do you want to come to this Jam?


Anything else you wish to share?


Please share with us a mini-bio, of about 1 paragraph in length, that talks about your life and work and accomplishments. If you are accepted to the Jam, we want to be able to promote you and link you to others in the Jam community, potential funders, and other possible allies. Check out www.yesjams.org if you want to see how some of our past alumni have been described in their mini-bios.

We realize these are challenging questions, and we appreciate the time you take to reflect and answer them as deeply as you can.

Travel and Tuition

We are committed to raising the funds necessary to enable the participants we select to attend the Jam. However, it is vital to our ability to create this event that those who can, pay as much as they are able.

If you come to the Jam, what airport, in which city and country, would you be coming from?



Please check with a travel agent on the current cost of a ticket for you to come to the Jam in Cusco, Peru (or into Lima and we can arrange an additional flight to Cusco separately). Travelers coming from Asia, Europe, Africa or Oceania please also check the most economical gateway city, seeing how the price changes if you route through any of the following options: Sao Paulo (Brazil), Caracas (Venezuela), Miami, Atlanta, Dallas and/or Los Angeles (USA),

How much (if any) can you or your organization afford to pay or commit to raising for your travel, food, lodging, materials, tuition etc.?

If you believe you may be able to pay the full costs of tuition for your participation in the jam, or are interested in offering a donation to support others’ participation, please let us know and we can discuss the specifics.