REGISTRATION APPLICATION

Intertribal Springs Workshop

june 5-7, 2017, Flagstaff, arizona

cost

Free to all tribal members
Non-tribal participant registration - $295
Non-tribal student rate - $175

Maximum 100 participants - Register today.

 

Instructions

Springs Stewardship Institute
Attn: Jeri Ledbetter
3101 N. Fort Valley Rd.
Flagstaff, AZ 86001

Please fill out the required fields on the form below. All tribal members - please include your affiliation in the appropriate field below for verification purposes.

All non-tribal participants: you may either pay for your registration using a Credit Card or mail a check to the following address -->

+After we receive your registration application and payment confirmation, we will send you an email confirming your reserved spot in our workshop.

Name *
Name
Address *
Address
Phone *
Phone
Please provide the name of your tribe, organization, foundation, university, or other affiliation.
Please select if you are registering as a tribal member, student (must provide proof of enrollment), or as a regular participant (all non-tribal, non-student participants).
(STUDENTS ONLY) Please provide your Student ID # and University Registrar's contact information to verify your enrollment at a 2 or 4 year university or college.
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Please provide any additional information or comments in the text area below.