The Arizona Indian Education Association invites you to the YOUTH CONFERENCE 2012 Northern Arizona University-High Country Conference Center www.aieacorp.com For additional information email: kathleen.frank@nau.edu or michael.luna@coconino.edu For registration information email: kathy.savala@phxschools.org Pre-Registration Deadline: October 12, 2012 Late Registration after October 12, 2012 Workshop topics will include: Higher Education, Family/Communities, Health & Wellness, Culture, Life Skills, and More!! Sponsors: Governor Jan Brewer, through the Governor s Office of Education Innovation, and the College Access Challenge Grant Arizona Department of Education Arizona Indian Education Association Arizona Tri-Universities for Indian Education (ATUIE) Coconino Community College MCCCD Office of American Indian Outreach Program Northern Arizona University - Office of the President and Native American Cultural Center
TABLE OF CONTENTS: General Information... 1 Registration... 2 Parking... 3 Hotel... 4 Agenda... 5 Youth Guidelines & Agreement Form... 6 Adult & Chaperone Guidelines & Agreement Form... 7 Registration & Liability Form... 8 GENERAL INFORMATION Conference Goals: To honor youth and their ability to transform our communities in a positive way, To provide youth the knowledge and skills to achieve their academic and career goals, and To inform youth on educational and career opportunities through interactive activities and workshops Conference Features: Keynote presentation Education/Career Information Door Prizes Educational workshop topics will include: Higher Education, Family/Communities, Health & Wellness, Culture, Life Skills, and More!! Pre-Registration Fee: $100.00 per applicant (Begins August October 12, 2012): Late registrants are accepted based on space availability A $20.00 late fee will be assessed for registrations received after October 12, 2012 No refund Substitute are acceptable Who should attend? Grades 7 12 American Indian students Meals: Two continental breakfasts for both conference days Two luncheon buffets for both conference days Pizza Party at AIEA College Information Fair NAU Native American Cultural Center Main Conference Location: NAU-High Country Conference Center, For general information about the conference please contact: Kathleen Frank, Co-Chair: Phone: (928) 523-9557 E-mail: kathleen.frank@nau.edu Michael Luna, Co-Chair Phone: (928) 226-4314 E-Mail: michael.luna@coconino.edu OR Visit www.aieacorp.org for general conference information and scholarship & registration forms Page 1 of 10
available for download. REGISTRATION You may register for the conference through the mail or E-mail. To get updates on the conference, regularly visit www.aieacorp.org. For questions about Registration, please contact: Kathy Savala, AIEA Treasurer Phone: (602) 257-4051 E-mail: kathy.savala@phxschools.org FOR ADULTS For education coordinators, school staff, chaperones, adult registrants, or those making reservations for students, please follow these instructions: 1. Complete Registration Form marked Adult Registration Form and Participant Release, Indemnity, Assumption of Risk and Photo Release Statement Form. 2. If you are a chaperone, please read and sign the Chaperone Guidelines & Agreement Forms as well. 3. If you need an invoice to complete your payment process, contact Kathy Savala at: Phone: (602) 257-4051 E-mail: kathy.savala@phxschools.org 4. If you are registering any students, please collect these forms from the students. Remember that both student and parents must fill out the Youth Guidelines and Agreement Form, and the Participant Release, Indemnity, Assumption of Risk, and Photo Release Statement Form. 5. MAIL payment and all forms (yours and your students) to: AIEA P.O. Box 13402 Phoenix, AZ 85002 FOR STUDENTS If you have been selected or plan to attend this year's conference, please follow these instructions: 1. Read and complete the following forms: a. Youth Registration Form b. Youth Guidelines and Agreement Form c. Participant Release, Indemnity, Assumption of Risk, and Photo Release Statement Form 2. Both YOU and a PARENT/GAURDIAN must sign the Youth Guidelines and Agreement Form and the Participant Release, Indemnity, Assumption of Risk and Photo Release Statement Form. 3. Submit forms to staff members who is registering you for the conference or if you are registering yourself only, mail payment and forms to: AIEA P.O. Box 13402 Phoenix, AZ 85002 Page 2 of 10
PARKING INFORMATION General Parking: The main conference and workshops events will be held at the NAU-High Country Conference Center. Enclosed is a campus/parking map of the NAU High Country Conference Center. If parking outside of the High Country Conference Center parking structure, there will be a $5 per day parking fee. Another parking lot that s designed for the conference participants will be on the NAU Campus in Parking Lot 13 (see below map). This option is located near the NAU Cline Library however space is limited. There is NO FREE street parking on or around Northern Arizona University campus. Bus Parking: There is NO CHARGE for bus parking at High Country Conference Center. Buses with government plated can park in parking lot P13 behind the NAU Cline Library. NAU-High Country Conference Center NAU Native American Culture Center NAU Campus Parking Lot 13 Page 3 of 10
Conference Host Hotels & Rates Courtyard/Springhill Suites By Marriott Flagstaff 2650 S. Beulah Rate: $89 by October 6, 2012 T 928-774-5800 F 928-774-5860 www.flagstaffcourtyard.com Drury Inn and Suites Adjacent to Conference Center 300 S. Milton Road T 928-773-4900 F 928-773-2606 Rate: $102 to $149.99 by September 28, 2012 https://wwwc.druryhotels.com/ Courtyard/Springhill Suites By Marriott Flagstaff 2650 S. Beulah Rate: $89 by October 6, 2012 T 928-774-5800 F 928-774-5860 www.flagstaffcourtyard.com Days Inn 2735 S. Woodlands Village Blvd. Rate: $59.99 - October 14, 2012 T 928-779-1575 F 928-779-0044 www.flagstaffdaysinn.com Embassy Suites Flagstaff 706 S. Milton Road Rate: $109 by October 1, 2012 T 928-774-4333 Ext. 294 F 928-774-0216 www.flagstaff.embassysuites.com Hampton Inn and Suites Flagstaff-West/NAU 2400 S. Beulah Blvd. Rate: $97 by October 14, 2012 T 928-913-0900 F 928-913-0800 www.flagstaffsuites.hamptoninn.com ** Mention AIEA Youth Conference or Youth Conference when making hotel lodging reservation. Page 4 of 10
TENTATIVE AGENDA October 29, 2012 8:00 10: 00 AM Registration/Continental Breakfast (provided) 9:00 9: 45 AM Opening Ceremony Welcome Remarks AIEA President Northern Arizona University Coconino Community College Conference Overview and Logistics 9:45 10:00 AM Break 10:00-11:15 AM Workshop Session I 11:15 11: 30 AM Break 11:30-12:15 PM Lunch (provided) 12:15 1:00 PM Keynote Speaker 1:00 1:15 PM Break 1:15 2:30 PM Workshop Session II 2:30 2:45 PM Break 2:45 4:00 PM Workshop Session III 4:00 4:15 PM Back to Main Conference Area 4:15 4:30 PM Main Conference Room Housekeeping Announcements 4:30 5:00 PM Transition to NAU Native American Cultural Center (NACC) 5:00 6:30 PM AIEA/ATUIE College Information Fair and Pizza Party at NAU NACC October 30, 2012 8:00 9:00 AM Continental Breakfast (provided) 8:45 9:00 AM Morning Welcome 9:00-10:00 AM Morning Announcements/Group Recognition Scholarships & Awards 10:00 10:15 AM Break 10:15-11:30 AM Workshop Session IV 11:30-12:15 PM Lunch (provided) 12:15 1:00 PM Keynote Speaker 1:00 1:15 PM Break 1:15 2:00 PM Student Panel 2:00-2:30 PM Closing Remarks Closing Prayer 2:30 PM Campus Tour (Optional) 2:45 PM End of Conference 3:00 PM Fry Bread Social at Coconino Community College (Optional) ** Please note: Conference Agenda subject to change without notice. ** Page 5 of 10
YOUTH GUIDELINES & AGREEMENT FORM To ensure the health, safety, and welfare of all student participants and to maintain the full-participation and an orderly and enjoyable experience for everyone, all youth and chaperone registrants must read, sign, and adhere to the guidelines and agreement(s) provided. I, (print full name) understand and agree that: 1. Smoking, alcohol, illegal drugs, weapons, and fighting are not allowed at Northern Arizona University High Country Conference Center and will not be tolerated during the 2012 American Indian Youth Conference. I acknowledge if I am caught participating in the mentioned activities or in possession of the mentioned items, I lose all privileges to attend the conference and my chaperone will be responsible for transportation arrangements off of the premises. 2. I agree to refrain from using any electronic devices (cell phones, MP3 players, handheld games, or any other distracting devices) during the conference. If I fail to follow this guideline, the items will be taken away and returned at the end of the day. Proper security for confiscated items will be provided, but Conference Committees and Staff personnel will not be responsible for lost or damaged items. 3. Dress code: I agree to dress in a manner appropriate and acceptable to the educational nature of the American Indian Youth Conference. I will not dress in any way that may cause distraction, disruptions, or conflicts amongst other attendees. Hats of any kind, bandanas, or any type of clothing bearing gang symbolism will not be worn during my conference attendance. 4. I agree to not wander away from the conference premises during scheduled American Indian Youth Conference activities. I also understand, if conference staff report thefts or damages on my behalf, my parents could be held liable for my actions. 5. I agree to behave and respect others in a mature manner that does not allow for loud talking, yelling, vulgarity, profanity, horseplay, or any other derogatory behavior. 6. I understand I will need to work with my chaperone to select the conference workshops I will attend. I agree to report promptly to all activities and events held throughout the conference, as an active participant. 7. I understand if I violate any of the guidelines during my participation in the American Indian Youth Conference activities, my parent/guardian or school chaperone may be notified. Youth Signature: Date: Parent/Guardian Signature: Date: Page 6 of 10
ADULT & CHAPERONE FORM Group Chaperones may complete one agreement and include with group registration Adults & chaperones must work to ensure and make youth aware: 1. All registration forms and emergency information for each student is completed and returned for participation in the AIEA 2012 American Indian Youth Conference (AIYC). 2. All school district/program policies will be followed and prior approval to participate in the 2012 AIYC has been approved by respective authorities. 3. All youth attending the conference understand and abide by the Youth Guidelines and Agreement. 4. Consistent contact with youth participants will be maintained throughout the conference to ensure students are attending scheduled 2012 AIYC workshops, activities and meals. 5. Youth will work with chaperones to identify the workshops sessions they will attend during the conference and be prompted to all scheduled meals and activities. 6. In the event the chaperone is called away from the conference or is required to leave due to an illness or other unforeseen circumstances, arrangements from another representative from the respective school, district, or program will assume the duties of lead chaperone for the assigned students. 7. I/We understand conference committee members attending the conference will monitor our responsibilities as chaperone. I/We will do our best to help ensure the success of the conference. 8. I agree to remain with the students throughout the conference. 9. I will refrain from using cell phone, lap top, and/or any electronic devices in the presence of students throughout the conference. District/School/Program Affiliation (if applicable): By signing the agreement, I/We will uphold the standards set forth in this agreement and take responsibility for the youth assigned. Lead Chaperone Name (Print): Relationship: Signature/Date: Phone: Additional Group Chaperones: Name (Print): Phone: Name (Print): Phone: [ ] Special Needs Request: Page 7 of 10
One or more members of my group have a disability or special needs and will need special accommodations. (Depending on disability or receipt or application, AIYC may not be able to fulfill all requests.) Page 8 of 10
Youth: Adult: REGISTRATION FORM First Name: Last Name: Date of Birth: Tribal Affiliation (if applicable): Mailing Address: City: State: Zip: Phone: School: E-mail: Grade: REGISTRATION FEES: NON REFUNDABLE ALTERNATES ACCEPTED Registration fee per applicant $100.00 Send payment with required registration forms to: AIEA, P.O. Box 13402, Phoenix, AZ 85002 Late Fee Additional $20.00 if received after October 12, 2012 Deadline Late registrants are accepted based on space availability. METHOD OF PAYMENT: [ ] Check/Money Order payable to AIEA (do not send cash) [ ] Purchase Order # Participant Release, Indemnity, Assumption of Risk, and Photo Release Statement This Release, Indemnity, Assumption of Risk, and Photo Release statement covers all activities, events, sessions, meals, occurrences, participation, observation, and travel between activities, associated with the Arizona Indian Education Association (AIEA) 2012 American Indian Youth Conference (AIYC) at Northern Arizona University-High Country Conference Center and Coconino Community College in. For my child, I agree to assume the risk that unexpected events may occur, which result in harm, injury, illness, damage or loss of my child s property associated with my child s participation, observation or other items covered in this release. I will not hold liable AIEA, Northern Arizona University-High Country Conference Center and Coconino Community College, or any of its agents, volunteers, or other organizations involved in the 2012 American Indian Youth Conference. I understand the AIYC and other activities associated with the conference are voluntary and I agree to accept the responsibility for my child s personal safety. I consent to the provision of emergency medical treatment for my child or myself to the extent the treatment is necessary in the medical opinion of the doctor rendering the treatment. If I have any concerns about my child s ability to participate in any event or activity associated with the Arizona Indian Education Association s AIYC, I agree to discuss my concerns with my child s physician before signing this form. I further authorize the Arizona Indian Education Association, NAU-HCCC, and CCC to film, videotape, photograph, or otherwise record my child s participation in the 2012 American Indian Youth Conference and its affiliated activities and to reproduce and use this file, videotape, or recordings of my child s name, likeness, voice, and brief biographical material in connection with non-commercial promotional activities, materials, website, or media releases related to the conference. Legal Guardian s Name (Print): Relationship: Signature/Date: Phone #1: In Case of Emergency: If my child requires emergency medical treatment and I cannot be reached, please notify the alternate emergency contact: Name: Relationship: Phone Number: FOR OFFICIAL USE ONLY: Received by: Date: [ ] Check/Money Order # [ ] Purchase Order # Page 9 of 10