2021 NEXUS Arab Future Summit Application

*Only fields with a red asterisk are required to be completed*

PERSONAL DETAILS

First Name (for name tag)

Last Name (for name tag)

Birth Date (MM/DD/YYYY)

Gender

Do you identify with any of the following diasporas?

Company/Organization

Title

How did you learn about NEXUS? (Please indicate the person's name, if applicable.)

Have you attended a NEXUS Summit or Event before? If so which one, where, and when?

Biography

CONTACT INFO

Phone

Primary Mailing Address

Street Address

City

State / Province

Zip / Postal Code

Country

Add Secondary Address?

Secondary Address

Secondary City

Secondary Country

Secondary State / Province

EVENT PREFERENCES

NEXUS shares our summit agenda via a private online networking platform in advance of the Summit: May we share your name, title, affiliation, bio & photo on our private online platform?

YesNo

Dietary Preferences:

Host a NEXUS Member - Make a difference & a friend. If you live in the host city, do you wish to host a social entrepreneur overnight during the summit?

Yes

SOCIAL IMPACT PROFILE

Your NEXUS Story - Please share any new ideas/activities you have pursued, inspired by your past NEXUS engagement? How have you connected/collaborated with other members?

NEXUS defines a PHILANTHROPIST as an individual wealth creator, inheritor or trustee whose family gives away significant personal or foundation capital each calendar year.
NEXUS defines an IMPACT INVESTOR as an accredited investor who invests significant money aligned with ESG principles.

Characterize Yourself - Given the above definitions, which of these titles best suits you?

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Your Passions - List your social impact passions & how are you working to accelerate change in these fields?

Your Interests - What issue areas are you interested in learning more about & creating impact around? (Please choose up to 5)

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Your Goals - What do you hope to gain from your participation in the event?

Unique Value - What are you excited to share/contribute to the community? How will you add unique perspectives, experiences, ideas or opportunities?

Family Business - Do you and/or your family have a business? If so, please share the name, industry, and what your role is, if any.

Personal/Family Philanthropy - What philanthropic donations do you, your family or family business make? (Describe what kinds of non-profits/social causes you support & the impact you've made.)

Personal/Family Impact Investing - If you, your family or family business make impact investments, please describe social-impact companies/funds invested in & any impact investing strategies employed. (Please differentiate between investments made by you or your family/your family business.)

Giving Process - In line with the questions above, please describe the decision-making process for you and/or your family's giving & investing. Are you a decision maker?

Board Affiliations - Do you hold any titled roles serving as an advisor, trustee, or board member to a grant-making foundation, non-profit or company?

Network Affiliations - Are you a member of any of the following networks?

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ACCELERATE IMPACT WITH NEXUS

NEXUS is engaging select financial institutions around better aligning money & values with impact. Interested in collaborating to advance social change through investments? If YES, answer the below.

Which financial institutions is the majority of you/your family's capital managed by? (Choose up to 2)

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How much (in an amount) of your personal or family’s collective assets do you have a decision making role in today (foundation, real estate, trusts, brokerage accounts, investments etc)?

How much (in an amount) do you expect to have a decision making role over 5 years from now?

REFERENCES

To help ensure the integrity of the NEXUS network we ask delegates to provide at least one reference. This can be a personal or a professional reference.

Reference

First name

Last name

Company / Organization

LET'S GET SOCIAL

Facebook Profile URL (Share for an invite to our private NEXUS Facebook Group.)

LinkedIn URL

Twitter @handle

Instagram Profile

Website (Personal or Company)

Blog/Other Social Media

YOUR PHOTO

New Photo:

NOMINATIONS

Strong preference is given to Applicants who include nominations of family members, friends or colleagues that you believe share the NEXUS Spirit, fit the NEXUS criteria & will add value or find value in joining NEXUS.

Nominee

First name

Last name

Company / Organization

Why are you nominating this person for NEXUS?

How would you characterize this nominee? (choose up to 3)

If your Nominee is accepted to NEXUS, do you wish to contribute to a scholarship to enable them to join the summit?

Yes

Package Options

Local Tickets

No transportation and No Accommodation.

Everything Else is included.

If you live in any of the following countries or had to leave as a refugee and have financial difficulties, you are eligible for full scholarship to the Summit. You will get the Green Package for free, and all other packages at cost

NEXUS COMMUNITY CODE OF CONDUCT

Check the boxes below to agree that you will uphold our Code of Conduct.

1. Non-Solicitation:

Including but not limited to business/fundraising efforts and promotions.

2. Safe Space:

Free from verbal, online, physical or sexual harassment and assault. Free from discrimination on the basis of nationality, race, class, religion, age, ability, sexual orientation, perceived gender identity or expression.

3. Drugs & Alcohol:

Official summit events are drug-free and alcohol is to be consumed responsibly.

4. Violations:

Violations should be reported to redflag@nexusglobal.org and can be grounds for dismissal. As a private community, NEXUS reserves the right to rescind summit acceptance or community membership at any time for violations of the Code of Conduct or for other reasons.

5. INDEMNIFICATION & RELEASE:

My application for NEXUS, participation in NEXUS events or being a NEXUS member are all voluntary and at my discretion. In consideration of this, I freely agree to release, waive, discharge, and covenant not to bring any claim against NEXUS, its fiscal sponsor - The Giving Back Fund--the officers, directors, agents, and employees of either (collectively, “Releasees”), either in law or equity, from any and all liabilities, claims, actions or causes of action, damages, costs, illness, injury, loss and/or responsibilities of whatever kind or nature now known or hereafter known (“Action”) arising out of, resulting from, or in connection with membership in NEXUS or participation in any NEXUS event or activity, whether such Action results from the negligence of the Releasees or for any other cause. This Release is intended to be as broad and inclusive to the fullest extent permissible by law, including but not limited to damages or losses caused by negligence, fault or conduct of any kind on the part of the Releases, including but not limited to illness, disability, death, economic loss or out of pocket expenses or loss or damage to property arising out of or attributable to my participation in and attendance at any NEXUS event or activity. I covenant not to make or bring any claim I, my heirs, assignees, next of kind and/or legally appointed or designated representative, may have or which may hereinafter accrue on my behalf against NEXUS or any Releasee, and forever release and discharge NEXUS and all Releases from liability under such claims. I agree to indemnify and hold harmless the Releasees against any and all claims, actions, suits, procedures, costs, expenses, damages, liabilities, and expenses of whatever kind, including court costs and attorney fees, brought as a result of my participation in NEXUS and its activities and to enforce any indemnification right under this Release, and to reimburse NEXUS and all Releasees for any such expenses incurred. This Release constitutes the sole and entire agreement of NEXUS and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability will not affect any other provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction.

Special Accommodations - NEXUS is committed to hosting summits that offer accessible environments for all delegates. Please email ehab @NEXUSGlobal.org as far in advance of the summit as possible with any specific accessibility or accommodation requests. We are a non-profit with financial restraints, but will do our best to meet your needs.

HAVING DIFFICULTY SUBMITTING THE FORM?
PLEASE SCROLL UP AND COMPLETE ALL REQUIRED FIELDS, MARKED WITH AN ASTERISK OR HIGHLIGHTED IN RED. If you are still experiencing problems email info@nexusglobal.org.