EARLY REGISTRATION

Joining the Waters: A Forum on Tribal Sovereignty and Water Quality in Wisconsin
October 21 & 22, 2005
Lake of the Torches Conference Center
510 Old Abe Rd.
Lac du Flambeau, WI 54538
Tel: 1-800-258-6724

Registration is easy! You can click here to register by mail.

To register online, first, click on the ePower button below to pay the $10 per person registration fee (it will open in a new window). The registration fee does not apply to children under twelve years old. The registration feel will be collected as a tax-deductible donation to Midwest Environmental Advocates. Please make select Midwest Environmental Advocates from the ePower list given, select $10 as your donation amount and specify Joining the Waters 2005 in "other special instructions." Then, fill out the registration form below.

Click this ePower button to pay the registration fee!

 

Registration Form

Full Name :

Street Address:

City:

State:

Zip Code:

Telephone:

Fax:

Email:

Tribal Affiliation:

Business, Organization, or Group:

Age:

Emergency contact:

Emergency contact phone:

Do you have any medication or medical problems? Yes No
If yes, please specify:

Will you need accommodations for the evening of October 21, 2005? Yes No
Note: We have reserved a block of hotel rooms at Lake of the Torches for the evening of October 21, 2005. Participants should contact Lake of the Torches directly to make a room reservation, and inform Lake of the Torches that they are attending Midwest Environmental Advocates' event.

Will you be representing an organization at the Forum? Yes No
If yes, would you like to reserve a table for your organization's brochures, reports, and other materials? Yes No
Note: Space is limited to 10 tables. If possible, please coordinate to share table space with another organization you know is attending.

If you are an attorney, will you be seeking Continuing Legal Education Credits for this event? Yes No

Are you interested in financially sponsoring the Forum to defray the costs of the event? Yes No

Have you already paid the $10 per person registration fee using the ePower button above? Yes No

If you do NOT intend to attend the lunch at 12:00 pm on October 22, 2005, please mark this box:

By clicking the Submit button below, you agree to the following:

I, my heirs, assigned representatives, executors or administrators, hereby release from and promise to hold harmless of any bodily or mental harm, injury, loss, illness, or death, Midwest Environmental Advocate s, Inc. and their officers and members, member groups, employee advisers, agents or representatives, that may result in my participation in “Joining the Waters: A Forum on Tribal Sovereignty and Water Quality in Wisconsin” or travel to and from the event. I have read the foregoing and submit this of my own free will without any coercion or duress.