May 17-19, 2022 May Coalition Meeting: Bois Forte Fortune Bay, Tower, MN.

Registration/Travel Scholarship Request Form

Meeting and Lodging Location:

Fortune Bay Casino

1430 Bois Forte Road, Tower, MN. 55790

May 17: 12:00p-5:00p

May 18: 9:00a-5:00p

May 19: 9:00a-2:00p

*Masks, social distancing, and vaccinations are encouraged*

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* 1. Contact Information

Name

Address

Org or Role in Community

Tribal Affiliation

Email Address

Phone Number

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* 2. I am:

Registering to attend virtually- please send me a Zoom link!

Registering to attend in person , but I am covering all of my own costs

Registering for a Travel Scholarship for mileage and lodging

Other (please specify)

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* 3. Please indicate scholarship needs

Hotel Fee @ $96/Night

Mileage @ $.585/Mile for driver (mapquest required)

My Organization is covering my travel costs

I am covering my own travel costs

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* 4. If requesting a Scholarship: Please reserve my room for:

Only the night of Tues. May 17

Only the night of Wed. May 18

Both nights, checking in Tues. May 17 after 3pm, checking out Thurs. May 19 by 11am

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* 5. Will you be lodging with one or more persons?

Yes

Please list room mate(s):

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* 6. Will you be carpooling?

Yes

Please list primary driver:

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* 7. Are you a service provider or Advocate? Please list:

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* 8. Are you a survivor of sexual violence? (Please answer only if comfortable)

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* 9. Ability Accommodations/Restrictions (please list):

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* 10. Additional Comments

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* 11. Please provide a brief paragraph about why you are requesting a scholarship and how attending this gathering will benefit you, your family, your program, or your community.