2019 LooChoo Identity Summit (LIS) Registration Form
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?
Age 75 years + ($100)
Student with valid ID ($80)
Optional: Hawaiian plate dinner for Saturday night 'Kanikapila'
Yes. Please order a dinner plate for me. I'm including an additional $20 with my payment
No thank you.
Check made payable to Ukwanshin Kabudan: Mailed to PO Box 892725, Mililani, HI 96789
Payment submitted via PayPal
Will pay with credit card. Please email invoice to me.
Any comments or concerns?
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