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Northwest Tribal Environmental Public Health Gathering

1. Registration Form

Date: July 17-18, 2024

Time: 8:30am to 4:30pm

Location: Kiana Lodge
14976 Sandy Hook Rd NE, Poulsbo, WA 98370

Hotel: Suquamish Clearwater Casino Resort

15347 Suquamish Way NE, Suquamish, WA 98392

(360) 598-8700

**ROOM BLOCK COMING SOON**

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* 1. Contact Information

Name:

Position:

Tribe/Organization:

Email Address:

Phone Number:

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* 2. Do you have any dietary restrictions?

Gluten Free

Dairy Free

Vegetarian

Vegan

Other dietary consideration (please specify)

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* 3. Photo Release

By checking this box, you are authorizing the Northwest Portland Area Indian Health Board, as well as its collaborating partners to utilize any photographic images taken at the conference to be used for promotional purposes.

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* 4. What size T-shirt do you wear?

2XL

3XL

4XL

No thanks

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* 1. Contact Information

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* 2. Do you have any dietary restrictions?

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* 3. Photo Release

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* 4. What size T-shirt do you wear?

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* 5. Any Questions or Comments?