Fall 2023 & Winter 2024 Base Camp and Leadership Summit Registration Form

CONTACT INFORMATION

District Name*

Superintendent Name*

Superintendent Email*

Contact Name*

Contact Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

REQUESTED SEATS AND PREFERRED COHORT DATES

The estimated value of each seat is $3,600. GLISI awards a per-seat credit of $900 making the price of attendance $2,700 per participant.

# Seats *

Enter the number of cohort seats requested (minimum of 5) in # Seats.

Price: $2,700.00

Please indicate cohort preferences in the boxes below (1 = 1st choice, 2 = 2nd choice). Cohort preferences are honored on a first-come, first-served basis.*

Cohort 68 (Sept 13–15 & Nov 6–8)	Cohort 69 (Jan 29–31 & March 4–6)

We are currently only accepting registrations for the our fall and winter experiences. Would you like to receive updates regarding our summer 2024 Base Camp and Leadership Summit experience?

Yes, please send me updates on the summer experience as they become available.

You will receive an invoice upon registration. Please provide contact information for invoicing in the spaces below.

Invoicing Contact Name*

First Last

Invoicing Contact Email*

Invoicing Contact Phone*

Preferred method of invoicing*

Invoice upon confirmation of registration
Invoice on July 1

Financial Hardship*

If the registration fee will prevent you from attending, please use this space to provide a brief narrative explaining your financial hardship. Additional scholarship assistance may be available. Priority for financial assistance will be given to registrations received by May 12, 2023.

STRATEGIC ALIGNMENT

Please provide a brief overview of how attending Base Camp and Leadership Summit aligns with your improvement plan.*

What outreach methods influenced your registration?*

Select all that apply:

Brochure or Postcard
Outreach from GLISI Staff
Facebook
Twitter
Website
Colleague Referral
Other

Please provide a brief explanation*

SUGGESTED DISTRICT COMMITMENTS & TIPS ON SELECTING TEAM MEMBERS

Click here to download and read the "Suggested District Commitments" and "Tips on Selecting Team Members."

CANCELLATION POLICY

GLISI will confirm your reservation pending seat availability upon receipt of this form and will invoice upon confirmation unless other terms are agreed upon by you and by GLISI. All invoices are due within 30 days of invoice date. Registrations are only valid for the Fall 2023 and Winter 2024 cohorts. Cancellations, reductions in team size, or requests to adjust invoice terms are not guaranteed and should be made in writing by May 12, 2023 with a request to Jennie Welch at jennie.welch@glisi.org.

SUPERINTENDENT AUTHORIZATION

Check the box next to each statement to verify that the Superintendent has reviewed and agreed.*

The Superintendent has read the "Suggested District Commitments" and "Tips for Selecting Team Members" above.
The Superintendent agrees to adhere to those guidelines to support the success of our Base Camp/Leadership Summit team/s in leading systemic improvement.
The Superintendent has read the cancellation policy above.

REGISTRATION

Fall 2023 & Winter 2024 Base Camp and
Leadership Summit

GLISI will confirm your reservation pending seat availability upon receipt of this form. For full details about dates and location, click here.
Questions? Please e-mail Jennie Welch at jennie.welch@glisi.org.

CONTACT INFORMATION

REQUESTED SEATS AND PREFERRED COHORT DATES

STRATEGIC ALIGNMENT

SUGGESTED DISTRICT COMMITMENTS & TIPS ON SELECTING TEAM MEMBERS

CANCELLATION POLICY

SUPERINTENDENT AUTHORIZATION

Fall 2023/Winter 2024 BCLS Registration

CONTACT INFORMATION

REQUESTED SEATS AND PREFERRED COHORT DATES

STRATEGIC ALIGNMENT

SUGGESTED DISTRICT COMMITMENTS & TIPS ON SELECTING TEAM MEMBERS

CANCELLATION POLICY

SUPERINTENDENT AUTHORIZATION

Category	Types of Data and Purpose
Use of Site	When you visit or otherwise utilize the Site, we may ask you for your name, address, telephone number, email address, or other contact details in order to offer services and respond to any request or inquiry.
User Account Information	You may be able to create an account or submit a registration on the Site. If you decide to create an account or submit a registration form, we collect your contact information and ask if you would like to submit other identifying information and demographic information in addition to your username, your password, and registration information.
Cookies and Similar Technologies	Please see the Cookies and Similar Technologies section of this Policy below. If you choose to disable cookies and similar technologies, some areas and features of the Site may not work properly.
Automated Information	When you visit our Site, we automatically collect information from your browser or your mobile device, which includes the date and time of your visit, your Internet Protocol (IP) address or unique device identifier, domain server, your browser type, cookies and data about which pages you visit in order to allow us to operate and provide the Site and our services. This information is used to understand how you interact with the Site and to provide you with advertising and a more personalized experience. To learn more about our collection of technical data, please see the Cookies and Similar Technologies section of this Policy below.
Email Interconnectivity	If you receive email communications from us, we may use certain tools to capture data related to if/when you open our message and if/when you click on any links or banners it contains. Other information collected through this email tracking feature includes: your email address, the date and time of your "click" on the email, a message number, the name of the list from which the message was sent, a tracking URL number, and a destination page. We use this information to enhance our marketing efforts. We do not sell or distribute this information to third parties.
Mailing List, Newsletters, and Marketing Materials	When you sign up for one of our mailing lists, newsletters, marketing lists or download or access other marketing materials, including but not limited to free or trial software versions as well as whitepaper(s), we collect your contact information, including your email address, phone number, and/or postal address, when necessary to contact you in the way(s) that you request.
Feedback / Support / Inquiries	If you provide us with feedback or contact us for support or to ask us questions, such as any contact forms, we may collect your name, address, telephone number, email address, and other information needed to respond to your feedback, or request for support, or to answer your question.
Your Communications	When you communicate with us, we may retain your communications in order to process and respond to them, as well as to improve our services. We may use your email address to communicate with you about our services or send you periodic emails. If at any time you would like to unsubscribe from receiving future emails, you may unsubscribe through the provided method.
Financial and Payment Information	If you or your organization choose to purchase services from us, we may collect your or your organization's name, address, telephone number, bank account number, bank routing information, and other data necessary to process payments. By submitting your payment information, you expressly consent to the sharing of your information with third-party payment processers and other third-party services (including but not limited to vendors who provide fraud detection services to us and other third parties). Please note that credit card numbers and account information are not stored on our servers.
Third Party Information	In addition to the information that we collect from you directly, we may also receive information about you from other sources, including third parties, business partners, our affiliates, or publicly-available sources.

Category	Disclosure Contexts
Subsidiaries and Acquisitions	We may share your personal information with our subsidiaries and affiliates and with their respective officers, directors, employees, accountants, attorneys and agents. In addition, we may disclose your personal information in the event of a merger, divestiture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our company assets, whether as a going concern or as part of bankruptcy, liquidation, or similar proceeding, in which personal information held by us about the Site's users is among the assets transferred.
Disclosures With Your Consent	We may ask if you would like us to share your personal information with other unaffiliated third parties who are not described elsewhere in this Policy. We will only disclose your personal information in this context with your consent.
Disclosures Without Your Consent	We may disclose your personal information in response to subpoenas, warrants, court orders or other legal process, or to comply with relevant laws. We may also share your personal information in order to establish or exercise our legal rights, to defend against a legal claim, to investigate, prevent, or take action regarding possible illegal activities, suspected fraud, safety of person or property or any other violation.
Service Providers	We may share your personal information with our service providers that need access to your information to provide operational or other support services on our behalf. Among other things, service providers may help us to administer the Site, support our provision of services requested by you; provide technical support; send marketing, promotions and communications to you about our services; provide payment processing; and assist with other legitimate purposes permitted by law. All such third-party service providers are required to maintain the confidentiality of your information and are prohibited from using your personal information except for the purposes for which we disclose it to them or as required by law.
Aggregated Data	We may disclose aggregated information about our users, and information that does not identify any specific individual, such as groupings of demographic data and customer preferences, for new product and marketing development.

Category	Types of Data and Purpose
Use of Site	When you visit or otherwise utilize the Site, we may ask you for your name, address, telephone number, email address, or other contact details in order to offer services and respond to any request or inquiry.
User Account Information	You may be able to create an account or submit a registration on the Site. If you decide to create an account or submit a registration form, we collect your contact information and ask if you would like to submit other identifying information and demographic information in addition to your username, your password, and registration information.
Cookies and Similar Technologies	Please see the Cookies and Similar Technologies section of this Policy below. If you choose to disable cookies and similar technologies, some areas and features of the Site may not work properly.
Automated Information	When you visit our Site, we automatically collect information from your browser or your mobile device, which includes the date and time of your visit, your Internet Protocol (IP) address or unique device identifier, domain server, your browser type, cookies and data about which pages you visit in order to allow us to operate and provide the Site and our services. This information is used to understand how you interact with the Site and to provide you with advertising and a more personalized experience. To learn more about our collection of technical data, please see the Cookies and Similar Technologies section of this Policy below.
Email Interconnectivity	If you receive email communications from us, we may use certain tools to capture data related to if/when you open our message and if/when you click on any links or banners it contains. Other information collected through this email tracking feature includes: your email address, the date and time of your "click" on the email, a message number, the name of the list from which the message was sent, a tracking URL number, and a destination page. We use this information to enhance our marketing efforts. We do not sell or distribute this information to third parties.
Mailing List, Newsletters, and Marketing Materials	When you sign up for one of our mailing lists, newsletters, marketing lists or download or access other marketing materials, including but not limited to free or trial software versions as well as whitepaper(s), we collect your contact information, including your email address, phone number, and/or postal address, when necessary to contact you in the way(s) that you request.
Feedback / Support / Inquiries	If you provide us with feedback or contact us for support or to ask us questions, such as any contact forms, we may collect your name, address, telephone number, email address, and other information needed to respond to your feedback, or request for support, or to answer your question.
Your Communications	When you communicate with us, we may retain your communications in order to process and respond to them, as well as to improve our services. We may use your email address to communicate with you about our services or send you periodic emails. If at any time you would like to unsubscribe from receiving future emails, you may unsubscribe through the provided method.
Financial and Payment Information	If you or your organization choose to purchase services from us, we may collect your or your organization's name, address, telephone number, bank account number, bank routing information, and other data necessary to process payments. By submitting your payment information, you expressly consent to the sharing of your information with third-party payment processers and other third-party services (including but not limited to vendors who provide fraud detection services to us and other third parties). Please note that credit card numbers and account information are not stored on our servers.
Third Party Information	In addition to the information that we collect from you directly, we may also receive information about you from other sources, including third parties, business partners, our affiliates, or publicly-available sources.

Category	Disclosure Contexts
Subsidiaries and Acquisitions	We may share your personal information with our subsidiaries and affiliates and with their respective officers, directors, employees, accountants, attorneys and agents. In addition, we may disclose your personal information in the event of a merger, divestiture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our company assets, whether as a going concern or as part of bankruptcy, liquidation, or similar proceeding, in which personal information held by us about the Site's users is among the assets transferred.
Disclosures With Your Consent	We may ask if you would like us to share your personal information with other unaffiliated third parties who are not described elsewhere in this Policy. We will only disclose your personal information in this context with your consent.
Disclosures Without Your Consent	We may disclose your personal information in response to subpoenas, warrants, court orders or other legal process, or to comply with relevant laws. We may also share your personal information in order to establish or exercise our legal rights, to defend against a legal claim, to investigate, prevent, or take action regarding possible illegal activities, suspected fraud, safety of person or property or any other violation.
Service Providers	We may share your personal information with our service providers that need access to your information to provide operational or other support services on our behalf. Among other things, service providers may help us to administer the Site, support our provision of services requested by you; provide technical support; send marketing, promotions and communications to you about our services; provide payment processing; and assist with other legitimate purposes permitted by law. All such third-party service providers are required to maintain the confidentiality of your information and are prohibited from using your personal information except for the purposes for which we disclose it to them or as required by law.
Aggregated Data	We may disclose aggregated information about our users, and information that does not identify any specific individual, such as groupings of demographic data and customer preferences, for new product and marketing development.

REGISTRATION

Fall 2023 & Winter 2024 Base Camp andLeadership Summit

GLISI will confirm your reservation pending seat availability upon receipt of this form. For full details about dates and location, click here.Questions? Please e-mail Jennie Welch at jennie.welch@glisi.org.

CONTACT INFORMATION

REQUESTED SEATS AND PREFERRED COHORT DATES

STRATEGIC ALIGNMENT

SUGGESTED DISTRICT COMMITMENTS & TIPS ON SELECTING TEAM MEMBERS

CANCELLATION POLICY

SUPERINTENDENT AUTHORIZATION

Fall 2023/Winter 2024 BCLS Registration

CONTACT INFORMATION

REQUESTED SEATS AND PREFERRED COHORT DATES

STRATEGIC ALIGNMENT

SUGGESTED DISTRICT COMMITMENTS & TIPS ON SELECTING TEAM MEMBERS

CANCELLATION POLICY

SUPERINTENDENT AUTHORIZATION

Fall 2023 & Winter 2024 Base Camp and
Leadership Summit

GLISI will confirm your reservation pending seat availability upon receipt of this form. For full details about dates and location, click here.
Questions? Please e-mail Jennie Welch at jennie.welch@glisi.org.