"2017 Partners In Action" Conference Registration Form
A Public Website Registration Form
Conference Location: Mystic Lake Casino and Convention Center - Prior Lake, MN. July 18th - 20th, 2017.
You will receive lodging information upon completion of this form.
Privacy Notice:
The Department of the Interior (DOI), Bureau of Indian Affairs (BIA) is requesting this information for the Midwest Region's 2017 Partners in Action Conference on July 18th - 20th, 2017. Your registration information will only be used to promote future Partners in Action Conferences. Providing this information is voluntary; however, it is necessary in order to receive future notifications. BIA will not share this information with third parties for promotional purposes. Please review the DOI Privacy Policy for how information is handled at DOI: http://www.doi.gov/privacy.cfm.
First Name
Your answer
Last Name
Your answer
Work Address
Your answer
Your answer
Example: WI
Your answer
Zip Code
Your answer
Work Phone #
please use the following format 715 763-3166
Your answer
Work email:
Your answer
Federal/Tribal Office, ie: (BIA, OST, Tribal Office, etc.)
Place of employment
Your answer
Job Title:
What is your work place position title?
Your answer
Registered via:
How did you register?
Select One:
Special Needs/Remarks/Considerations?
Please list any concerns or comments you may have below.
Your answer
Conference or Consultation?
What is your reason for attending?
Is this your first Partners in Action Conference?
Authorization and Release - Photography *
Still Photography, Video and/or Sound Recording, Printed Endorsements by the U.S. Department of the Interior's Bureau of Indian Affairs, Midwest Region (MR) for the following project: Partners in Action Conference. The MR shall own the full copyright and source materials produced for this conference, and resulting promotional products or ideas. I agree I will not receive compensation of any kind or in any form. I have read the above statements and am familiar with their content. I warrant that I am competent and of full age (18 years old or older) and have every right to contract in my own name in the above regard.
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