ISNA CON 63- BEAM Venture Youth Innovation & Entrepreneurship Track

ISNA CON 63 – BEAM Venture

Youth Innovation & Entrepreneurship Track
Student Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Grade Level / Year in College
School / University Name
Email Address (Student)
example@example.com
Phone Number (Student)
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information (For minors)
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact
Full Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Community Information
Which masjid, Islamic school, or faith community do you belong to?
Would you be interested in helping start a BEAM Venture chapter in your community?
Program Participation
Youth Startup Showcase Participation
Team Name
Number of team members (1–6)
List team members (names)
What areas are you most interested in?
Background & Interests
Have you participated in entrepreneurship or innovation programs before?
If yes, please share details.
If you could build ANY project or startup — with no limits — what would it be? (Share as much or as little as you'd like.)
What do you hope to gain from this experience?
Waivers
Participant Agreement & Liability Waiver
Do you grant permission for photography/video to be used for MASCON & BEAM Venture educational and promotional purposes?
BEAM Venture Institute and ISNA CON 63 has my permission to use my or my child’s photograph publicly to promote BEAM Venture Institute and ISNA CON 63. 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.

Participant's Signature (Parent if minor under 18)
I agree that this Waiver and Release of Liability shall apply to each day I or 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 and ISNA CON 63, 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 Venture Institute and ISNA CON 63's programs and activities. I further agree to release, indemnify, defend and hold BEAM Venture Institute and ISNA CON 63 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)
Parent's Signature
Participant Signature
Should be Empty:

Student Information

Parent/Guardian Information (For minors)

Emergency Contact

Community Information

Program Participation

Background & Interests

Waivers