Yurok tribal design

19th Annual State ICWA Conference Registration
June 19-21st 2012

Registration Fee: $50 Per Person, please make checks payable to the Yurok Tribe. Registration is limited and will close on June 4th.
Once you have registered you will receive a confirmation via email so please be sure and provide your email!
Registration will be waived for presenters and key note speakers.

Conference Registration Form
Use a separate form for each registrant.

Name Title

Tribal Leader Attorney Judge Service Provider Social Worker ICWA Worker/Advocate
Family Advocate Administrator Presenter Speaker Other

CEU- MFT’s/LCSW’s additional fees may apply MCLE – legal

Organization/Tribe: Mailing Address: City:

State: Zip: Phone: Fax: E-Mail:

Signature: Date:

Are you a member of the Tribal Caucus ICWA workgroup? YesNoDon't Know

Will you be attending the preconference Tribal Caucus workgroup session on June 18th @ 5:00? YesNo

For registration information and questions please contact Jessica Clayburn email jclayburn@yuroktribe.nsn.us or call (707) 482-1350 EXT 1342.

Conference Coordinators- Yurok Social Services Director- Stephanie Weldon sweldon@yuroktribe.nsn.us, Judge Abby Abinanti aabinanti@gmail.com, and CILS Directing Attorney- Delia Parr dparr@calindian.org.