First Name *

Last Name *

Email Address *

Telephone Number *

Mailing Address *

Address - City *

State *

Zip Code *

Date of Birth (mm/dd/year) *

Are you a tribal member or descendant of a federally recognized Tribe? *

Reservation of Enrollment or Descendancy *

I hereby authorize the Tribal Enrollment Department to release an OFFICIAL tribal blood certification to the Lac Courte Oreilles Ojibwe College at 13466W Trepania Road, Hayward, WI 54843 ATTN: Registrar’s Office, for the purposes of college enrollment only. I understand the information is confidential and the above organization will use it only for the stated purpose. *

By checking this box I give LCOOC Extension Dept the right to record and photograph my (and the minor children under my supervision) participation in this workshop. The photos may be used to market and promote Extension programming and may be used on the website, social media, newsletters, and other articles. *

Do you want to receive a certificate of completion by mail? *

Workshop Registration for February, 2021- Check all that you will attend, then you only need to submit this form 1 time. The Zoom Meeting ID for all classes will be 380 374 5351 and the Password is LCOEXT