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AI JAM US Entry Form 2023 Word

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AI-JAM US APPLICATION FORM

Instructions
Please complete the application form for your work. All text must be written in
English. Fill out all information on the application form and send it to us via email
(team@aijam.org), no later than the 4th of August, 2023 unless there have been
any updates to the deadline.
When you send it by email, please write email title [Submission] and your country.
You can get this form at the AI-JAM US competition page, accessible via the
registration link www.aijam-us.com

Applicant Information

Name
(head of delegation or team leader)

Country

Email

Institution, School, or Organization

Street:
City:
Address
Province:
(awards and certificates will be mailed to this ad-
Country:
dress)
Zip Code: Please provide it correctly.
Phone Number:

Application Details
Work Type: Please check
- Invention [ ]
- AI Application [ ]
- Academic Research Paper [ ]
- Kids Picture Book with AI [ ]
Category: (Pleas write down below)
(please choose the most relevant category):
- Agriculture
- Architecture
- Arts and Music
- Chemistry
- Computer Science
- Artificial Intelligence
- IoT
- Others
- Education
- Engineering
- Environment
- Social Science
- Human Science
- History
- Economics
- Business
- Health and Medicine
- Public Safety
- Sports and Fitness
- Transportation
- Other (please specify)
Title: (Pleas write down below)

Author(s):

Abstract/Summary (max 500 words):

Keywords (3-5 words):

Video (YouTube link or any link to view video presentation):

Payment Details
Please select payment option (if you join on-site competition, you only pay on-site fee.):
- Online Competition: $350 USD [ ]
- On-site Competition: $550 USD [ ]
Payment should be transferred to:
SWIFT CODE : CHASUS33
Bank Name : Chase
Company Name : Headstart Silicon Valley, Inc.
Account Number : 792883287
Routing Number : 322271627
Account Type : Checking
Address of Bank : 37 N. Milpitas BLVD., Milpitas, CA 95035

** After payment, please confirm your payment by email team@aijam.org


Payment confirmation (insert payment
receipt here):

Agreement
By submitting this form, I confirm that:
- The work is my own original creation, or
- I have the right to submit this work on behalf of the author(s)
- I agree to follow the rules and regulations of AI-JAM
- I agree that AI-JAM Association may use my work for promotional purposes

Signature:

Date:

This document template is owned by AI-JAM Association and may not be used anywhere outside of
AI-JAM official competitions, without written consent.

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