Sample Registration Forms Conference

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          2007 CONFERENCE REGISTRATION FORM
 The Early Bird registration ($185/person general or youth) ends April 16, 2007. After that date, the
 Registration fee is $200. Late/On-Site Registration (after July 2, 2007) is $250 with no guarantee
 that all conference materials will be available at check-in. We request that all conference
 attendees pre-register to assure the availablity of all conference materials. To register, please
 complete this registration form and return it with payment to NIJC (see below). Confirmation of
 your conference registration will be mailed to you. Please complete a separate registration form for
 each conference participant. If you have any questions, please contact NIJC staff at (707)
 579-5507 or e-mail us at nijc@aol.com.
Please Print Clearly ( Information is used for your name tag)
 Mr.          Ms.        First Name:                               Last Name:

General         Youth (17 and under)

 Your Tribe:

 Title/Job Position:

 Employer:

Mailing Address:

City:                                       State     AL                      Zip:

Phone Number                                 Fax Number

 E-mail

 Please indicate any special needs (i.e. Dietary or Disability):

                                         REGISTRATION PAYMENT
 Payment Type:             Early Bird               Standard Registration        Late/On-Site Registration
 Amount:                $185                   $200                            $250
 Deadline:              Before: 4/16/07       After: 4/16/07                  After 7/2/07

        Check or Money Order payable to NIJC               Check or Money Order #

        Credit Card               Visa              Mastercard        American Express                 Discover

 Card Number                                                              Exp. Date

 Signature:

  Return this form to NIJC by fax (707) 579-9019 or mail to NIJC, 5250 Aero Drive, Santa Rosa, CA 95403.
                      We look forward to meeting you at this very important conference.

				
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