Single Day 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 by mail, or purchase
order. Please check payment method below. 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 registration rate of $40.00, 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.
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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: $40.00 ($50.00 after 10/31/11)
Cancellation: Refunds minus $10 administration fee will be made if notice is made to OICWA on
or before 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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Day Attending: (Select Only One)
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Mon., Nov. 14, 2011
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Tues., Nov. 15, 2011
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Wed., Nov. 16, 2011
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Comments:
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How will you pay registration fee? (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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