KPN! Registration Women's Peace Walk and DMZ Action An international delegation hosted by Korea Peace Now! to the Korean Peninsula featuring a Women's Peace Walk, DMZ crossing and vigil for peace. 1 Personal Information2 Passport/Visa3 Travel4 Miscellaneous5 Pre-Trip Education For any questions regarding registration please contact Jessica Thompson at jtricoche@secure.nobelwomensinitiative.orgContact InformationPreferred Name*Please enter your full name as you would like it to appear on your delegation badge and other delegation communication. A separate field will be provided for passport name.Organization Name*Enter the name of the organization you are representing for this delegationRole*Your role at the organization you are representing.Mailing Address* Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Time Zone*Please enter your time zone. e.g. EST - Eastern Standard Time (GMT - 5:00)Mobile*WorkMobile phone while travelingProvide the phone number you use during travel if different from the one provided above. Please note we will use the Signal app to communicate during the delegation. Please download this app and provide the number used here if different from your primary mobile phone.Email* Email 2 Your secondary email or email for someone you would like copied on correspondence.WebsiteBiography & PhotoPlease submit a photo (headshot) and short biographical description of yourself and your work. Please do not submit a resume or CV. Bios should be no more than 150 words. For sample biographies see: Nobel Women’s Initiative Staff BiosPhoto UploadAccepted file types: jpeg, jpg, gif, png.Only jpg, gif or png files with a maximum size of 2MB.Upload BioAccepted file types: pdf, doc, txt, docx.Only pdf, doc or txt files with a maximum size of 2MB and 150 words maximum.Enter BioPrivacy*Your photo, biography, and email address will be shared internally with campaign staff and other delegates. Do we have your consent to share information and photos externally as well (social media, with partners, etc.)?YesNo Delegation GroupDue to the current ban on Americans traveling to North Korea, we are coordinating a simultaneous trip of 35 international (non-US) women to travel to Pyongyang, Democratic People’s Republic of Korea (DPRK/North Korea) and 35 U.S. women to travel to Seoul, Republic of Korea (ROK/South Korea). On May 24, both delegations will travel to the DMZ, hold simultaneous peace walks, and meet at Panmunjom to hold a vigil for peace, including conducting a jogakbo (quilt) stitching ceremony symbolizing the role of women to help reunite Korea. The 70 U.S. and international women participating in the walk and vigil for peace would be a symbolic number representing the urgency and global commitment to help end seven decades of war. This delegation will involve two separate groups: Select the delegation you will be participating in below. Note: U.S. passport holders will not require a visa for entry to Seoul but should still review Vaccination Information when planning travel. Delegation*InternationalU.S. PassportPassport information is necessary to facilitate visas, arrange international flights and gain entry to government meetings.Passport Surname*Please provide your surname or family name as it is shown on your passport.Passport Given Name*Please provide your given or first name as it is shown on your passport.Date of Birth (yyyy-mm-dd)* Date Format: YYYY dash MM dash DD Passport Number*Country of Passport*Place of Issue*Date of Issue (yyyy-mm-dd)* Date Format: YYYY dash MM dash DD Date of Expiration (yyyy-mm-dd)* Date Format: YYYY dash MM dash DD Current country of residence?*Will you require a visa to enter Beijing, China?*YesNoChinese Visas Some international delegates will require a visa to enter China. After you register, we will contact you to provide additional visa information but it is your responsibility to apply for and secure your visa. (Please remember it is also your responsibility to determine if any TRANSIT visas are required for your flight itinerary.) DPRK (North Korean) Visas While in Beijing, KPN! will help facilitate DPRK visas Sponsored guests will be reimbursed for their visa related expenses on-site so please bring your receipts. Visit Visa Exempt Countriesto review a list visa exempt countries. Visit Application Requirements to review a list of visa application requirements. Note: apply for type L: tourist visa. Vaccinations Review Vaccination Information to identify any vaccination needs ahead of your travel. It is your responsibility to obtain a visa to visit Beijing. Please consult the website of your nearest Chinese Embassy in order to confirm the application procedure. Based on the information you provide in this conference registration form, KPN! will provide the following materials, which must be submitted with your visa application: 1) Visa support / host letter 2) Flight itinerary If you require additional support from KPN!, please indicate it in the field below. We strongly encourage you to begin the application process immediately.Other than the passport you indicated earlier in this form, do you hold other visas, residence permits or passports that would facilitate your entry to China & DPRK?*(e.g. multi-entry visa)YesNoIf yes, explain.Based on the passport(s) and visa(s) you already hold, do you need to apply for a NEW visa for entry to China?YesNoIf so, at which Chinese Embassy will you apply for your visa?When will you apply? Date Format: MM slash DD slash YYYY Other than a visa invitation letter, do you require special assistance with your visa?*YesNoIf yes, explain.If you require a visa, please upload a copy of the photo page of your passport.Only jpg, gif or png files with a maximum size of 2MB. TravelThe U.S. delegation schedule is as follows: May 20 - Arrive in Seoul May 21 - 23 - Site visits May 24 - DMZ peace walk and Vigil for Peace at Panmunjom May 24 - Depart South Korea The international delegation schedule is as follows: May 19 - Arrive in Beijing May 20 – Apply for DPRK visas and orientation May 21 – Travel to Pyongyang, DPRK May 21 -23 – Site visits May 24 - DMZ peace walk and Vigil for Peace at Panmunjom May 24 - Depart North Korea For sponsored guests, KPN! will book and cover the cost of your economy class round-trip flight. Based on the information you provide in the section below, our travel agent will email you a proposed flight itinerary for consideration. Please respond the agent within 48 hours. Note: Nobel Women’s Initiative will pre-pay for seat selection and one piece of checked luggage only. Self-funded guests should proceed with booking your own flights. Please send jtricoche@secure.nobelwomensinitiative.org your confirmed itinerary no later than April 20th. We rely on you to communicate to the travel agent any special needs or local expertise you have so together you can develop a travel itinerary that meets your needs for security, comfort and efficiency. We encourage you and remind you it is your responsibility to reject any travel itineraries that don't fully consider these needs. Are you attending the delegation as a:Sponsored guestSelf-funded guestWhich airport do you wish to travel from?*Which airport will you return to?*Preferred Arrival Date in Monrovia (yyyy-mm-dd)* Date Format: YYYY dash MM dash DD Preferred Arrival TimeMorningAfternoonPreferred Departure Date from Monrovia (yyyy-mm-dd)* Date Format: YYYY dash MM dash DD Preferred Departure TimeMorningEveningSeat PreferenceWindowAisleDo you have any frequent flyer plans, if so, please provide the airline and frequent flyer/account number:Please explain any special travel requests or concerns here.AccommodationsBased on your confirmed travel itinerary, KPN! will reserve and manage hotel bookings in Beijing, Pyongyang, and Seoul for all delegates. Sponsored guests should note you might be asked to share a hotel room with another delegate guest. KPN! will cover the cost of all sponsored guests’ rooms directly. If you have special requests or need to make changes to the hotel information you submit here, please email Jessica at jthompson@nobelwomensinitiative.org. Please do not contact the hotel directly.Do have alternative accommodation arrangements during your travel?*YesNoIf requested, are you willing to share a room with another delegation guest?*If no, you will be charged the cost difference for a private room.YesNoIf not, are you willing to cover the cost difference for a private room in the hotel?*YesNoWhich nights do you require accommodation at Boulevard Palace Hotel?Please select all that apply. Saturday, April 27 Sunday, April 28 Monday, April 29 Tuesday, April 30 Wednesday, May 1 Thursday, May 2 Friday May 3 Accomodation CommentsShare special requests or information here. Diet & HealthPlease select all that apply*NoneVegetarianVeganGluten-freeNo alcoholPlease identify any allergies and/or medical conditions we should be aware of.Emergency ContactPlease identify an emergency contact person. Name* Relationship to you*Emergency Contact Phone Number*Email* City / Country* City AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country InterpretationEnglish is the primary language for this event but some English to Korean interpretation will be provided.What is your primary spoken language?*What is your English language proficiency?*NoneBasicIntermediateFluentWhat is your Korean language proficiency?*NoneBasicIntermediateFluentIn which language do you prefer to receive written delegation materials?*If you require materials in a language other than English, please specify.EnglishAre you able to help with informal translations at meals, etc.?YesNoIf yes, please identify which language(s) Pre-Trip EducationTo prepare for this delegation, articles, readings, and movies related to the topic of Korean War, Peace Treaties, and Korean politics will be shared with delegates. We welcome your recommendations.Do you have materials you wish to share with other delegates?YesNoMaterial DetailsList your recommendations here (such as book titles, web links, etc).Suggested ReadingsIf you would like to suggest reading materials that relate to the topic or theme of this event, please let them here.PaymentThe registration fee for this conference is $1,000 USD. This fee includes your full participation in the 4-day multi-language event, including interpretation, airport transfers in Monrovia, ground transportation to/from the conference venue each day, meals during the conference, a full day of site visits and exciting Welcome and Closing Dinners. This fee excludes flight cost, hotel expenses and meals and incidentals outside of the conference schedule. Reimbursement Estimate*Please provide a reimbursement estimate that includes visa fees, vaccinations, and airport transit. Please note: if you require a financial advance to support your participation in this event, please let us know. You rely on you to let us know how to support you!Are you a self-funded guest who needs to pay the registration fee?*YesNoPayment Options*How do you wish to pay the registration fee? If you select "Pay online now using a credit card," you will be directed to another page after you hit submit. Just select "Event Registration" and fill in the form.Pay online now using a credit cardCall our office at +1-613- 569-8400 ext. 116 and pay using your credit cardSend a USD or CAD cheque made out to: Nobel Women's Initiative, 430-1 Nicholas St., Ottawa, ON K1N7B7. Include “Conference Registration” in the memo line.Email us at mprebinski@nobelwomensinitiative.org to have someone contact youPre-Trip Availability*Weekdays, business hours onlyWeekdays, anytimeWeekdays, eveningsWeekends, anytimeWeekends, daytime onlyA series of conference calls or webinars will be scheduled ahead of our time on the Korean peninsula to further education and preparation for this important action. Please select your best availability for these calls (separate polling will be done before scheduling).
