Learn, Experience American Democracy with Winthrop University ...

Learn, Experience American Democracy with Winthrop University August 31-September 3, 2012

Your students and faculty are invited to join Winthrop University for 2 ½ days of activities related to the 2012 Democratic National Convention in Charlotte, North Carolina. Possible agenda items include meeting the South Carolina delegation; observing a pre-convention committee meeting; interacting with news media, dignitaries, lobbyists, and protesters; and more. The weekend will end with attendance at the Labor Day Community Festival to be held at Lowe’s Motor Speedway in Concord, NC.

Early Registration Fee: $115 per person  50% nonrefundable deposit and institution

Late Registration Fee: $150 per person  50% nonrefundable deposit and institution

registration form due by May 1, 2012  Full payment due by July 31, 2012  Participant information and assumption of risk forms due with final payment  No refunds after July 31, 2012 Registration Fees include:  

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registration form due by July 1, 2012  Full payment due by July 31, 2012  Participant information and assumption of risk forms due with full payment  No refunds after July 31, 2012 What participants will need to provide:

Orientation Briefing on August 31, 2012 Daily round trip transportation from Rock Hill to Charlotte, September 1-3 Three nights of accommodations at Winthrop University or Bethelwoods Presbyterian Camp and Conference Center (August 31, September 1 and 2) Parking on the Winthrop University campus Meeting space in downtown Charlotte Access to all LEAD activities Snacks and drinks1 Supplies and identification

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Transportation to Rock Hill, SC and to bus pick up point in Rock Hill Spending money for meals for three days Comfortable walking shoes (no flip flops) Business Casual attire for three days Medication, health insurance card, and emergency contact information Linens, towels, toiletries, alarm clock, camera, cell phone Other insurance (as provided by institution for sponsored travel.)

Space is limited! Reserve your spaces now!

Questions? Please contact Professor Katarina Moyon, West Forum Assistant Director ([email protected]) or Dr. Karen Kedrowski, West Forum Director ([email protected]). Sponsored by the John C. West Forum on Politics and Policy. The mission of the West Forum is to promote civic engagement in South Carolina. For more information: www.winthrop.edu/westforum. 1

Fees do not include full meals. Participants will be responsible for their meals.


Institution Registration Form Institution Name:_________________________________________________

Please list all participants (faculty and students) who will participate in LEAD from your institution. Attach additional sheets as necessary. Name

Faculty or student?

Total Registration Fee Due: 2

Amount: $

50% Nonrefundable Deposit Enclosed

Amount: $

Please return institution registration form, participant information forms, assumption of risk forms, and payments to Professor Katarina Moyon, Department of Political Science, Winthrop University, Rock Hill, SC 29733. Please make checks payable to Winthrop University; Winthrop University will assess a $25 fee for all checks returned for insufficient funds.

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Fees are $115 per person for those registering on or before May 1, 2012; $150 per person for those registering by July 1, 2012. No refunds possible after July 31, 2012.


Participant Information Form (Please complete one per participant; due July 31, 2012) Name: ____________________________________

Preferred Name:________________________________

Address: ____________________________________________________________________________________ Cell phone (with area code): ________________

Preferred Email: _______________________________

College or University Affiliation: _________________________________ I am a: ______Faculty member ________Student

Emergency Contacts. Please include name and phone numbers for at least two persons to contact in case of emergency:

Medical/Physical Conditions and Allergies. Please list any medical conditions and allergies, including allergies to medications, of which we should be aware. Please indicate if you have any physical conditions or disabilities that inhibit walking, climbing stairs etc. for which you require accommodation:

Participant’s signature and Date



Assumption of Risk, Release and Indemnification (Please complete one per participant; due July 31, 2012)

I, ___________________________________, and the undersigned, in full recognition and appreciation of the hazards and exposures involved do hereby voluntarily agree to assume all of the risks and responsibilities involving my voluntary participation in LEAD (Learn Experience American Democracy) scheduled August 31-September 3, 2012, or any dependent research activities undertaken as an adjunct thereto; and, further, I do for myself, my heirs, and personal representative(s) hereby defend, hold harmless, indemnify and release and forever discharge Winthrop University and all its officers, agents, employees and volunteers from and against any and all claims, demands, and actions, or causes of actions of any sort on account of damage to personal property, or personal injury, or death which may result from my participation. I confirm that I have health and accident insurance in effect for the inclusive dates of my participation and no such coverage is provided to me by Winthrop University. I have read and executed this document with full knowledge of its significance. In witness whereof, I have caused this release and indemnification agreement to be executed this ________________day of ___________________, 2012.

Attendee/Participant________________________________________________ Date_______________ Parent/Guardian (if Attendee is under age 18) _____________________________ Date______________ Witness Signature __________________________________________________ Date_______________
