Name:

Company:

My Mission & Purpose:

Title/Area of Responsibility:

Work Mailing Address:

Home Mailing Address:

Telephone Number(s):

Work E-Mail Address:

Home E-Mail Address:

[NOTE: For privacy, a copy of your completed eVISA will be sent to this e-mail address only]

1. When did you first attend an AMI meeting?

2. What have been some of your AMI insights and learnings (2-3 lines):

3. Why do you want to go on this Thinking Expedition (2-3 lines):

4. Some unusual skills, background and experience I bring to the Thinking Expedition (3-4 items):

5. Some unusual adventures I have been on (3-4 Lines):

6. Some useful insights and discoveries I have made in life (2-3 Lines):

7. A little known fact about me (Almost nobody knows this) (1-2 Lines):

8.

Temperament
Idealist Rational Guardian Artisan

If you do not know your Temperament, please click on the link below to go to the Keirsey website to complete the Keirsey Temperament inventory.

9. My Myers Briggs Type - MBTI (if known):

10.

My KAI Style (Kirton Adaption-Innovation inventory) and subscores:
Total    O-score    E-score    R-score    Sorry, I don't know my KAI

11. Describe a radical innovation that you have seen or been involved with; what made it "radical"?

12. Some critical issues and challenges I face (3-5 Items):

13. In my experience, some major obstacles to innovation have been (3-5 obstacles & explanations):

14. Things I feel are important innovation enablers (3-5 items):

15. List any creative thinking and innovation tools or techniques you use regularly or are familiar with:

16. Stuff that you have used that works - that sparks innovation or innovative results (3-5 things):

17. Some great references, books, websites, et al that you have found useful are (list 5-7):

18. Unknowns relating to innovation that I hope to explore on expedition are (3-4 items):

19. The MESS, I see as Mt. Innovation is (2-3 lines):
[NOTE: A "Mess" is a complex collection of inter-related issues, problems, challenges, opportunities, background and history facing you and your organization - and is something YOU are interested in working on during the Thinking Expedition]

20. Some specific results I hope to return with (2-3 Results):

NOTE: School for Innovators Expeditions are mentally and physically intense. The days start early and end late, with the team's excitement and energy often driving the group - midnight is not unusual. Meals and breaks are largely unscheduled, taken when the opportunity presents itself. Basecamp is at 7,500 feet and outdoor activities sometimes move to as high as 12,000 feet. All that being said, if you are able to handle a brisk two or three mile walk at home, you should be able to participate fully. A daily walk of two to three miles is the best way to prepare yourself physically for the outdoors work. Conditions ranging from diabetes to four months pregnant to multiple sclerosis have not limited participation in the School for Innovators.

The outdoors work of every School for Innovators Expedition is tailored to fit the profile of the group. Answering the following questions will help us begin that assessment:

21. Please list the sports/exercise/fitness programs in which you regularly engage?

22. Please provide a brief history of back, knee, or shoulder problems, heart, respiratory conditions, altitude sickness, or any other conditions which you feel might effect your performance on the expedition?

23. Please list any dietary constraints (foods you cannot eat - or don't like to eat)?

24. Dates/timeframes that could work for me this summer are (please list several):

25. Dates/timeframes that will not work for me this summer are (please list several):

26. Preferred days (Ideally we need three overnights):

• Thursday PM - Sunday PM
• Thursday AM - Sunday PM
• Friday PM - Monday PM
• Friday AM - Monday PM
• Tuesday PM - Friday PM
• Tuesday PM - Saturday noon

This VISA is the first step in your nomination process for joining an upcoming School for Innovators Expedition. Once we have received and processed your initial eVISA application we will send you more detailed information about Expedition XLIX, logistics, travel, and some additional pre-work.

This eVISA is the first step in your self-nomination process for joining an upcoming School for Innovators Expedition. Once we have received and processed your initial eVISA application we will send you more detailed information about School for Innovators Expedition 50, logistics, travel, and some additional pre-work.