Registration Form

Northwest Tribal Tobacco Summit - Culture as Prevention
Date:
 Tuesday, May 22, 2018 and Wednesday, May 23, 2018
Time: 8:30am to 5:00pm
Location: Kiana Lodge
14976 NE Sandy Hook Rd. 
Poulsbo, WA 98370

Meeting Location Phone: 866-738-4307

Registration Deadline: May 11, 2018

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* 1. Contact Information

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* 2. Does your tribe have a policy in place addresssing:

  Yes No In Progress
Tobacco
Physical Activity
Nutrition
Wellness in the Workplace

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* 3. Would you be willing to share your tribal policies?

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* 4. Do you use culture in your tobacco program?

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* 5. If your tobacco program incorporates culture would you be willing to share as part of a group panel?

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* 6. Do you have any dietary considerations?

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* 7. Do you want to apply for a tribal travel and lodging scholarship?

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* 8. Any Questions or Comments?

For Hotel Reservations: Room Block "Tribal Tobacco Prevention"
Hotel: Clearwater Casino & Hotel
15347 Suquamish Way NE
Suquamish, WA 98392
Phone: 360-598-8700
Room Block Rates:  + tax
  • $134 - Resort water-view (double queen or queen breakout room with Murphy bed) 
  • $119 - Resort non-view kings 
  • $111 - Tower non-view (king or double queen) 
  • $126 - Tower northwest-view (king or double queen) 
  • $145 - Tower suites 
Hotel Website

Notes from the hotel for online reservations:
Go online to www.clearwatercasino.com, click on Stay & Play for reservations, click on Groups and use the Group ID 13070 to be added. 
The cut-off date for reserving a room is 4/27/18.

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