Women Are Sacred! Violence Against Native Women is Not Traditional!

TRAINING REGISTRATION FORM
Please input your information, print and fax to us at 605-341-2472.

 
Name:
Title:
Tribal Affiliation:
Tribe/Organization:
Dept./Program:
Address:
City:
State:
 Zip
Phone: Fax:


Email:
TRAINING ATTENDING
Training Title:
Training Date:
Location:
Attending the Ending Violence Against Native Women Training Institute? Please check workshop you will be attending.
(Check one only)
Role of Law Enforcement
Role of Batterers' Program
Role of Criminal Justice System
Role of Advocates

Native Women's Leadership

Please complete payment information: (Group Discount - $25 per person for 5/more attending same training)

Purchase Order # Invoice for Amount Payment on-site Pre-payment

Registration Amount: Group Discount:

TOTAL AMOUNT:

Mailing Check # for the total amount due.
If applicable, please list group member's last name(s):

For office use only: Reg. #______________ Date Rec: ______________________ By:______________

Print completed form and fax to Sacred Circle at 605-341-2472 - Thank you.