2019 LooChoo Identity Summit (LIS) Registration Form
Email address *
First Name *
Last Name *
Ancestral Family name (eg.Nakaganeku/Nakamura, Fija/Higa)
Mailing Address (line 1: house number, street name or PO Box number) *
Mailing Address (line 2: City, State, Zipcode) *
Contact Phone Number (area code + 7 digit) *
If you require special provisions (ADA), please describe accommodations needed:
Any Okinawan affiliations (e.g. clubs, music/dance groups, schools)?
What’s your ancestral Ryukyuan village(s)?
In what decade is your birth year? *
Registration Fees: *
Optional: Hawaiian plate dinner for Saturday night 'Kanikapila' *
Payment Information *
Any comments or concerns?
Submit
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