January 2014 Tribal Cancer Coalition meeting registration

1. Registration Form

Northwest Tribal Cancer Coalition meeting
Date: Thursday, January 23, 2014
Time: 11am to 4:00pm
Location: Embassy Suites
319 SW Pine St Google Map of Location
Portland, OR 97204
Phone: 800-643-7892

Question Title

* 1. Contact Information

Name:

Tribe/Organization:

Address:

City:

State:

ZIP Code:

Email Address:

Phone Number:

Question Title

* 2. Are you requesting to be considered for a tribal travel and lodging scholarship?

Yes

Question Title

* 3. Any Questions or Comments?

For Hotel Reservations: Room Block "Indian Health Board Meeting"
Hotel: Embassy Suites
319 SW Pine St
Portland, Oregon 97204
Phone: 800-643-7892
Website for Embassy Suites
Federal Rate: $126/night + tax
Parking: $36/night + tax