American Indian Health Research Conference

Registration

Registration for the day-long forum is only $25 and includes breakfast, morning snack, awards banquet buffet, afternoon snack, and conference bag with materials.

Deadline: For planning purposes, please register by Tuesday, October 6, 2009.

Three ways to register:

• Register online
• Register by mail or fax

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Registration Form

Name:
Position/Title:
Organization:
Address:
City:
State:		Zip Code:
Phone:
Email:
Special Needs
Pleace check any of the following that apply:
		I will be attending the INMED events October 22, 2009.
		I would like to receive Center for Rural Health publications and updates.
		I have applied for a student scholarship.
Payment Method
		Please send me an invoice for my registration fee ($25 US).
		Check # enclosed for $ Please make check payable to UND-CRH Mail to: Karen Speaker UND Center for Rural Health 501 N. Columbia Rd. Stop 9037 Grand Forks, ND 58202-9037 Fax: 701-777-6779

Special needs: The conference is being held in an accessible facility. If you need special accommodations, auxiliary aids or dietary arrangements, please send a written explanation with your registration form or call 701-777-0817.