2016 AIWPN Conference Online Registration
Please tell us your name. *
Your answer
What is your tribal affiliation, if applicable?
Your answer
What organization, school or company are you associated with?
Your answer
What is your mailing address? *
Your answer
City? *
Your answer
Your answer
What is your telephone number (best number to reach you) ? *
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What is your e-mail address? *
Your answer
Registration fee: *
Honoree in Program Book To honor or remember a special person during the conference, for $10 per name, the individual will be listed in the program book. Please include name and tribe (s). Your answer:
Your answer
Scholarships -- A limited number of scholarships/registration support is available for those requesting hardship. *
Your answer
Please note for payment!!!
As soon as you are done with your registration, please go back to bottom of registration and Pay online via PayPal

or you can send pay by check: Please make check out to : AIWPN


American Indian Women of Proud Nations
C/O Lana Dial
4216 Loch Harbour Lane
Raleigh, NC 27606
Email: lana_dial@yahoo.com

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