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MKW23 SUMMIT
OUR WORK
News
Events
Vision
Advocacy
Advocacy
Education & Research
Education & Research
MKW Theory of Change
MKW Summits
MKW19 Summit
MKW17 Summit
CONTACT
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MKW23 INDIVIDUAL REGISTRATION
Individuals are community members, students, youth, adults, and elders over the age of 18. Youth registrants under 18 years of age must be accompanied by an adult at all times and have parental/guardian consent and sign the form to register.
Name
(Required)
First
Last
Organizational Name (if any)
Tribal Affiliation (if any)
Gender (optional)
Date of Birth
(Required)
MM slash DD slash YYYY
Please select the option that best describes the location of your community:
(Required)
Urban
Rural
Tribal Nation
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Dietary Needs (if any)
Purpose: Water Issues Impacting Indigenous Peoples & Solution-Oriented Responses
The purpose of these questions is to learn about what participants hope to gain at the MKW Summit, and how Indigenous Peoples are responding to water issues. The responses to the following questions will be synthesized into MKW reports, social media content, programmatic work, and used for other media and content development purposes. This can include but is not limited to presentations, research, improving MKW programming, and development of workshops, trainings, and educational materials for local to international dissemination. Responses to questions are anonymous (no names will be used in the public dissemination of the data; only information such as geographic regions, general distinctions like “Indigenous Peoples” or “youth,” and similar information will be used), optional, and you can choose not to answer them. By completing the questions, you agree to hold harmless, and release Mni Ki Wakan, “MKW,” its employees, staff, consultants, and organizers from any and all liability claims, authorizing them (“MKW”) to utilize the data for the aforementioned purposes including and not limited to any other related purpose mentioned in this form.
What do you hope to learn and achieve at the Mni Ki Wakan Summit?
Is there a water issue impacting Indigenous Peoples you are responding to?
In what solution-oriented, and innovative (unique, unconventional, or new) ways are you responding to the issue?
EMERGENCY CONTACT
Emergency Contact Name
(Required)
First
Last
The emergency contact is an adult who can respond expediently and diligently in the case of an emergency.
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
PARENT/GUARDIAN/AUTHORIZER: YOUTH REGISTRANT (UNDER 18) TERMS & CONDITIONS
An adult must complete this form if the registrant (s) is under 18 years of age, and register separately. Youth under 18 years of age must be accompanied by an adult at all times. Organizations, programs, parents, or guardians assume full responsibility and liability for youth registrant (s) under the age of 18. By signing and registering a youth (s) under 18 years of age, you are verifying that you have obtained parental/guardian consent and the documentation to do so. The authorizer, parent, or guardian is solely responsible for the youth registrant and all associated responsibilities.
E-Signature (Authorizer/Parent/Guardian)
First
Last
By signing my/our signature, date, we agree to and fully understand the terms and conditions of this agreement provided hereto, are 21 years of age or older, and have obtained parental/guardian consent to register the youth registrant (s) and are acting on behalf of the parent/guardian or are the parent/guardian. I/We understand and agree to accompany the youth at all times, and are solely responsible for the supervision, care, and safety of the youth. I/We, being of lawful age, by affixing my/our E-signatures hereto, do hereby agree to indemnify and to hold harmless the Mni Ki Wakan, its officers, employees, elected officials and agents, from and against any and all liability claims, actions, causes of action, demands, rights, damages, cost, loss of service, expenses, any health issues, and compensation for all negligence whether active or passive arising out of or in any way connected or related to the Mni Ki Wakan.
Date
MM slash DD slash YYYY
Email (Authorizer/Parent/Guardian)
Phone (Authorizer/Parent/Guardian)
Date of Birth
MM slash DD slash YYYY
Address (Authorizer/Parent/Guardian)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
MEDIA RELEASE, LIABILITY WAIVER, AND COVID-19 HEALTH & SAFETY PROTOCOLS
Media Release Form
I agree to the Terms and Conditions of the Media Release Form.
I hereby grant Mni Ki Wakan, “MKW,” its employees, staff, officers, representatives, and consultants the absolute and irrevocable right and permission, in respect of the photographs and or video taken of me alone or with others, to use, re-use, publish, and republish the same in whole or in part, individually or in conjunction with other photographs or video, and in conjunction with any printed matter, or electronic matter, in any and all media now or hereafter known, and for any purpose whatsoever; and to use my name in conjunction therewith if Mni Ki Wakan so chooses.
I hereby release and discharge Mni Ki Wakan from any and all claims and demands arising out of or in connection with the use of the photographs or video, including without limitation any and all claims for libel or invasion of privacy.
This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of Mni Ki Wakan.
I am of full age (18) and have the right to contract in my own name. If I am not yet 18 years of age, a parent or guardian has authorized my signature. I have read the foregoing and fully understand the contents.
Liability Waiver Form
I agree to the Terms and Conditions of the Liability Waiver Form.
I/We the undersigned, being of lawful age, by affixing my/our signatures hereto, or checking the box hereto, do hereby agree to indemnify and to hold harmless the Mni Ki Wakan, “MKW,” its officers, employees, representatives, elected officials, consultants, and agents, from and against any and all liability claims, actions, causes of action, demands, rights, damages, cost, loss of service, expenses, any health issues, and compensation for all negligence whether active or passive arising out of or in any way connected or related to the Mni Ki Wakan Summit to be held on August 16-18.
COVID-19 Health & Safety Protocols
I agree to comply with the Mni Ki Wakan COVID-19 Health & Safety Protocols.
The 2023 Mni Ki Wakan Summit will require social distancing and participants to wear masks at all times (except when eating and drinking water). We ask participants to comply with Mni Ki Wakan health and safety protocols, and any applicable Center for Disease Control & Prevention (CDC) and state COVID-19 mandates and guidance that may be more stringent.
If you are feeling sick, have a cough, fever, or other symptoms, please do not attend. Mni Ki Wakan will have a health coordinator to provide masks and hand sanitizer. We will continue to monitor and update safety precautions for the Mni Ki Wakan Summit.
NEWSLETTER
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Our team is building a Mni KI Wakan Ecosystem where Indigenous Peoples and youth are creating a transformative and sustainable future for water and all life together. We invite you to join our newsletter; receive updates, news, event info, and other relevant information.
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