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Applicant Information


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
*	Country: Required
	If you respond and have not already registered, you will receive periodic updates and communications from Operation Smile.

*

Question - Required - Phone Number

Question - Not Required - T-shirt Size:

*

Question - Required - School Name (please type out name fully do not abbreviate)

*

Question - Required - Anticipated Graduation Year:

Question - Not Required - Area of Study/Major

*

Question - Required - What is your current involvement with Operation Smile?

Lodging Assignments:

*

Question - Required - Age:

*

Question - Required - Gender:

Male

Female

Meal Accommodations

Question - Not Required - Please check here if you require vegetarian meals.

Question - Not Required - Do you have any allergies to foods?

Question - Not Required - If yes, please explain:

*

Question - Required - Previous attendance of ISLC or STEP Up?

Yes

No

*

Question - Required - Member of an OS club?

Yes

No

*

Question - Required - Please select which event(s) you have attended:

	Step UP Symposium, January 2019
	ISLC Wake Forest University, North Carolina 2019
	Seattle, Washington 2018
	Rome, Italy 2017
	San Diego, SDSU 2016
	Other

Question - Not Required - If other, please list:

(Maximum response 255 chars, approx. 5 rows of text)

Participant Travel Information

Emergency Contact (available while you are traveling):

*

Question - Required - Name:

*

Question - Required - Phone:

*

Question - Required - Email:

Note: Participants flying in for the conference, please structure your flight to arrive at Norfolk International Airport (ORF) between 2 p.m. and 5 p.m. ET on Wednesday, January 5, 2022. Likewise, all participants must depart on flights after 2 p.m. on Saturday, January 8, 2022. Participants must submit the travel information form by December 19, 2021. Once participants arrive at ORF in Virginia, USA, Operation Smile staff and volunteers will transport them to the symposium hotel at Operation Smile Global Headquarters in Virginia Beach (if arriving during the specified time-frame). Operation Smile will not provide transportation to and from train or bus stations to the site.

*

Question - Required - I will be arriving by:

Car

Plane

Other (bus, train, etc. please specify below)

Question - Not Required - Please specify other mode of transportation:

The fee to attend the conference in person is $100 and must be paid by Sunday, December 19, 2021. The cost covers housing, meals, and materials. Transportation to and from Virginia Beach is not included in this fee. Participants are responsible for covering the cost associated with travel to and from Virginia Beach and the cost of obtaining a tourist visa (if applicable). If you are driving to the conference and are willing to carpool other students from Operation Smile HQ to the hotel and vice versa, please indicate that above. Your contact information may be shared with other Step UP participants in your area.

If you are interested in carpooling, please enter your city and state of origin. Your contact information may be shared with other Step UP participants in your area.

Step Up 2022 Symposium Registration

Lodging Assignments:

Meal Accommodations

Participant Travel Information