Dear friend, 

Thanks for your interest in joining the Ashoka Changemaker Summit 2021. 

1. Select Level of Engagement
This year´s summit is a 4 months hybrid process with a physical milestone in Turin, Italy, on December the 2nd. 

The in-person event tickets are being managed from an Eventbrite account. Please click in the following link to get your tickets:

This option is designed for members of the Ashoka community(*) and is invite-only, please check with your Ashoka contacts if you haven´t received an invitation with a code. 

(*) by Ashoka community we mean any member of our network who is directly engaging and supporting Ashoka or our fellows and young changemakers through Ashoka.
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2. Information From Attendees
This information will be public in the event platform to filter attendees
This information will be public in the event platform to filter attendees
This information will be public in the event platform to filter attendees
Pay as you want
Ashoka is a global non-profit organization that promotes social innovation and changemaking to build a more resilient, inclusive and equitable future. 

The Summit's online content is free and available to anyone who would like to watch. If you would like to make a voluntary contribution in order to support our work, please pay here as you wish. 

Thank you for your time and support. 

See you in September!
Payment Information
Media Consent

The following authorization and consent grants Ashoka, a non-profit organization based in Arlington, Virginia, (“Ashoka”, see full address below) permission to take photos and make video and audio recordings at the event you are registering for hosted by Ashoka (the “Event”) featuring you (collectively, the “Media Records”) and use such Media Records for public relations purposes of Ashoka as outlined below.

By authorizing and consenting below, you declare to have carefully read and evaluated the content of this Media Consent and to have clearly understood the meaning of each individual point before signing it.


You authorize Ashoka to make, modify, copy, archive, and otherwise use the Media Records, free of charge, for informative, promotional, and institutional purposes of Ashoka with or without stating your name.

Your authorization is granted without time or territorial limits and must also be understood as referring to the reproduction, publication, sharing, and dissemination of your image in any format or adaptation, including by press, television, event websites, and websites or social profiles used for the Events.

Your authorization expressly releases Ashoka from any liability for the use of your image, name, and voice, in compliance with your authorization and consent.


You consent to the processing of Media Recordings by Ashoka for informative, promotional, and institutional purposes as outlined above. Please note that such processing may include marking available or transferring such data to countries which may not provide an adequate legal protection for your privacy. You can revoke your consent at any time.


Your intellectual property authorization and your data protection consent can be revoked at any time with a written communication to be sent to Ashoka at 1700 North Moore Street, Suite 2000, Arlington, Virginia 22209-1939, United States, or by sending an email to

All personal data received about the undersigned will be processed in accordance with the applicable laws and regulations and Ashoka’s Privacy Policy. The Media Recordings will be processed with your consent as the legal basis for the purposes outlined above and deleted when they become irrelevant for such purposes. The recipients may be press or media organizations, non-profit organizations, Ashoka’s existing or potential members and supporters as well as the general public.

For further information about how Ashoka handles data of the undersigned and his or her rights, please see Ashoka’s Privacy Policy at

Your Personal Data will be processed outside the EEA as described in the Privacy Policy.

Ashoka envisions a world free of systemic oppression in which each individual has access to resources, voice, power and safety. Such a world will only emerge if the structural, institutional, and historical barriers that have led to the marginalization of women, Black people, Indigenous people and People of Color, religious minorities, people with disabilities, members of the 2SLGBTQIA+ community, and working-class people, are addressed. We, at Ashoka, are committed to making these barriers visible and gradually shifting the way that society and institutions have traditionally organized –placing some groups above others-, to allow the equitable and fair treatment of all people at Ashoka and beyond.  

This is why we are asking you to answer the following questions. Your self-defining answers will help us understand the community that we are part of and it will inform us in our evolution to become a fully diverse, equitable, and inclusive organization.
Optional Additional Fields - DO NOT DELETE
The fields below can be dragged up and used in your form if helpful
Else they can be left alone and will remain hidden.

Do not repurpose these fields for unrelated / new purposes - create a new field instead!

These fields are already 'mapped' to the corresponding fields on the campaign member in salesforce which makes everything easier and faster.  
if you delete these fields, things will break, and you may need to rebuild your form. 

dont say we didnt warn you!
Required Fields
this value is used in event campaign member status mapping. we can update the variable values in build - do not need to go into the connector anymore!  use \u0020 for spaces
Optional Fields - Required For Confirmation Email
dotmailer campaigns used for confirmation must be set as triggered campaigns, and must not contain social share / forward links (and a few other types).  See here for more details.

internal note - if user wants to include response in dotmailer notification, we need to modify the connectors manually at present.  can use this email address book id for testing : 2362852
Optional Fields - Required If Including Opt In
this sets formtype on connector to tfacomms or comms
required - this form is used to complete the double opt in process.   
must clone generic DOI Confirmation Form and update the URL here.
generic form :
site language iso controls the language of the double opt in email. currently the text of the opt-in email cannot be altered, just the language.
iso site country on webcontact controls which list the subscriber is added to when completing double opt in
By submitting this form, you consent to receive communications from Ashoka.