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Group Member Online Registration Form
Complete this form and submit electronically by clicking on the "Submit" button below. The
conference registration fee can be paid by credit card, check/money order, or purchase order.
After completing and submitting form, pay registration fee using your credit card by clicking on
the Pay Pal button on confirmation page. You may preregister using this form when sending
payment by mail or paying on site. To receive early rate of $70.00, payment must be
postmarked by 10/31/11 (or you must preregister by this date, if paying on site). Please
indicate below that you are preregistering online and mailing payment or paying on site. If you
would like to register by mail, download and complete Conference Registration Form. Each
group member must register separately.
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2011 Oklahoma Indian Child Welfare Conference
"Improving Outcomes for Indian Children Through Policy, Practice, and Partnerships"
Dates: November 14-16, 2011
Registration Fees: $70.00 per group member ($85.00 after 10/31/11)
Cancellation: Refunds minus $10 administration fee will be made if notice is made to OICWA by
10/31/11. Prepaid registrants unable to attend may send another person in his/her place..
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Your name:
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Job Title:
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Agency/Organization/
Tribe/Tribal Affiliation:
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Mailing Address:
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City/State/Zip Code:
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Phone Number:
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Fax Number:
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Email Address:
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Comments:
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How will you pay registration fee? (Please Check One - REQUIRED)
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By Credit Card (Use PayPal )
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Check or Money Order By Mail (Preregister)
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Purchase Order
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PO #:
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Check or Money Order On Site (Preregister)
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Please click Submit after completing fields. Submission is not complete until you are
directed to a confirmation web page screen. To pay registration fee with a credit
card, click on the PayPal button located on the confirmation web page screen.
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