Mail-In Registration

Mail-In Registration

Returning The Gift XI 2002 A Northwest Gathering
October 9^th – 13^th, 2002 Tacoma, WA

Last Name:__________________ First Name: _______________Middle Initial: ____
Title: _______________Organization: ______________________

Address:______________________
City:______________________
State/Province:________ZIP:_____
Country:__________________

Email: ____________________

Phone
Work:__________________ Home: ___________________
Cell: ___________________ Fax: ____________________

Registration Package:

Regular ($100.00 includes banquet dinner)
Student ($75.00 includes banquet dinner)
Student ($50.00 no banquet dinner)
Scholars ($100) See Below

All Students Must Provide A Photocopy of Their Student Picture I.D. With This Form As Verification of Their Student Status.

Hardship Scholarship Request: (State your special situation)

______________________________________________________________

SCHOLARS:

Your University or College? ___________________
Please state your expertise, or field of study.________________________
Do you teach Native American Studies? ____
Do you teach Native American Literature?____

Make Check or Money order out to:

The Raven Chronicles (Write on check: "for RTGXI 2002")

Please Send:

Registration Form - Check/Money Order - Support Material

To:
RTGXI 2002
c/o Philip H. Red Eagle
PO Box 612
Tacoma, WA 98401