BigSurv23 Registration Form

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Title

Name

First

Last

Organization

Indicate your background

Computer or Data Science
Social Science
Other background (please specify)

Are you currently enrolled full-time at a college or a university (i.e. a student)?

No, I am not a student.
Yes, I am a student

Conference Registration

I am member of IEEE
I am a member of the Survey Research Methods Section of the American Statistical Association (SRMS)
I am a member of the American Statistical Association
I am registering as a non-member
I am registering as an Ecuadorian Faculty member
I am registering as a member of USFQ community

Registration includes the welcome reception (beverages and appetizers), and snacks and beverages during the morning and afternoon breaks. It also includes transportation for attendees to and from the primary conference hotel (Go Quito Hotel).

Will you be attending a Short Course?

Short Courses are scheduled for 26 October. Please note that a short course will be cancelled if the minimum number of people is not completed. In that case, you will be offered enrollment in another course if space is available, or this part of your registration fee will be refunded. For more information on the Short Course topics and instructors, see https://www.bigsurv.org/shortcourses.

Welcome Reception (Included in registration)

I WILL attend the Welcome Reception (free)
I WILL NOT attend the Welcome Reception (free)

Thursday, October 26th at 18:45–20:30, Shakespeare Theater Hall, Universidad San Francisco de Quito (Cumbayá).

Conference Dinner (Tickets can be purchased separately)

I will not attend the Conference Dinner
Conference dinner – Complete Ecuadorian Dinner ($76.25)
Conference dinner - Fish ($76.25)
Conference dinner - Vegetarian ($76.25)
Conference dinner - Other dietary requirements (please specify) ($76.25)

Friday October 27, limited availability. Dinner includes a 3-course Ecuadorian typical meal, wine and beverages, served at a restaurant with spectacular views of Colonial Quito. Before dinner, attendees will visit the breathtaking Church of the Society of Jesus in Quito in a private tour. Cost includes dinner, private tour, and transportation.

Conference dinner guest (Tickets can be purchased separately)

I will not bring a guest
Guest Conference dinner – Complete Ecuadorian Dinner ($76.25)
Guest Conference dinner - Fish ($ 76.25)
Guest Conference dinner - Vegetarian ($ 76.25)
Conference dinner - Other dietary requirements (please specify) ($ 76.25)

One-Day Tour to Colonial Quito and "Mitad del Mundo" (Tickets can be purchased separately)

I WILL attend
I WILL NOT attend

Sunday October 29.

Guest for One-Day Tour to Colonial Quito and "Mitad del Mundo" (Tickets can be purchased separately)

I WILL bring a guest
I WILL NOT bring a guest

Sunday October 29.

Will I be using the shuttle departing from GoQuito Hotel to USFQ (Included in registration)

Shuttles to and from the University at the beginning and end of Friday and Saturday will be offered departing from GoQuito Hotel.

Special Assistance

Would you like a printed copy of the program? The program will be available on-line.

Yes, I would like a printed copy of the program.
No, I would not like a printed copy of the program.

*BigSurv23 attempts to be environmentally friendly. Although there will be a PDF program, we will provide printed programs only to attendees who explicitly request it.

Preferred name for your conference name badge (please specify).

How did you hear about the conference (please specify).

Photo Release and Consent

I understand and agree to be bound by the photo release and consent.

I hereby consent to the photographing of myself and the use of these photographs singularly or in conjunction with other photographs for advertising, publicity, commercial or other business purposes of the United Nations Association of Ecuador (UNA-Ecuador). I understand that the term "photograph" as used herein encompasses still photographic images.

I understand that my image may be edited, copied, exhibited, published-or distributed by any means or method now known or hereafter invented, and I waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I understand and agree that UNA-Ecuador are and shall be the exclusive owner of all rights, titles, and interests, including copyrights in such images, and I waive any right to royalties or other compensation arising or related to the use of my image.

I understand that photographic images of me may be electronically displayed via the Internet on a site or profile managed by UNA-Ecuador, and I hereby expressly consent to such use.

I further consent to the reproduction and use, or authorization by UNA-Ecuador to reproduce and use, such photographs in all international markets.

I hereby irrevocably release and hold harmless UNA-Ecuador and their affiliates, their directors, officers, agents, employees and customers, and any advertising agencies authorized by UNA-Ecuador, their directors, officers, agents and employees, from any and all liability, including but not limited to any claims, judgments, damages, losses and expenses (including attorney's fees) for libel, defamation, invasion of privacy, infringement of any rights of publicity, infringement of moral rights, or otherwise arising out of the capture, use, editing, alteration or omission of photographs in the manner described above. To the extent that moral rights may not be waived, I hereby agree not to bring or allege any claims or actions against UNA-Ecuador, or anyone obtaining rights through UNA-Ecuador, for infringement of moral rights in relation to the content described above.

Are you a speaker, panelist, or poster presenter?

Acknowledgements

I understand the travel and accommodation requirements.

I am responsible for obtaining the required travel documents to Ecuador. Note: If you need an invitation letter to the conference to obtain a visa please reach out to info@bigsurv.org. I am responsible for making my own travel and accommodation arrangements. Please see the list of conference hotels on the website.

Note for students: If you indicated that you would like to share lodging, we will provide you with names and contact information of students of the same gender who have indicated that they would like to share a room. By checking the box, you consent to this information being shared.

Payment for the conference is required to complete my registration. Payment by credit/debit card (Visa, Mastercard, Diners Club, Discover) has already been made in the previous step.

Cancellation Policy

I have read and agreed to the cancellation and refund policy that can be found here: https://aenu.ec/bigsurv23-cancellation-policy/

How we will use your information

I have read and agree with the privacy statement.

We will use the information you provided in your account and the information on this form to contact you and provide updates on behalf of the United Nations Association of Ecuador (UNA-Ecuador) for the BigSurv23 Conference. By registering for the conference you agree that:

• We may continue to send you information about BigSurv23.
• We will be storing and processing your information.
• For accounting and tax and purposes, we will process your personal data, and you authorize its use.
• For BigSurv23 (co-)presenters and (co-)authors: We will be storing and processing the information you provided as part of the abstract submission.

We will use your information only for the purpose of conference administration and providing you with information about the conference which may include events and logistics around the conference, important updates, or other valuable information concerning your attendance. You can stop receiving email or request a deletion of your data by emailing info@bigsurv.org (Note: the request of discontinued email or deleting your data implies that you will not be able to attend the BigSurv23 Conference).

Please write any questions or remaining comments