Good Day Participants,

Welcome to Native Fitness X, July 30 & 31, 2013. We would like to thank you for registering for this event.

Registration fee is $200, and non-refundable. Please note the participants name on the registration payment, which can be made by check or money order.

Also past experience has led us to recommend that you please bring your own comfortable Nike shoes for training because there will be some outside training sessions on grass that may be wet. You may not want to wear your new shoes.

-To register, please submit one registration form for each participant
-First time attendees will be given preference
-Please limit registration to three (3) participants per organization or tribe and coordinate with your diabetes program
-Please apply only if you can attend the entire length of the training
-Participants must be 18 years or older
-Each participant will receive one pair of Nike Athletic Shoes
-Payments can be made by check or money order
-Prepayment is required, we cannot accept payment on-site



*By completing this registration form, 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.


Question Title

* 1. Registrant Information

Question Title

* 2. Do you work with your Diabetes Program?

Question Title

* 3. Shoe Type:

Question Title

* 4. Shoe Size:

Question Title

* 5. Select One:

Question Title

* 6. Check, Purchase Order or Money Order Number

Hotel Information:

Hilton Garden Inn
(503)439-1717
Group Rate at: $139.00
Last day to reserve rooms: July 9, 2013

Homewood Suites
(503)614-0900
Group Rate at: $189.00
Last day to reserve rooms: May 31, 2013

Fairfield Inn & Suites
(503)972-0048
Group Rate at: $139.00
Last day to reserve rooms: June 29, 2013

Please reference the "NW Portland Area Indian Health Board" when making your reservation to receive the group rate. Participants are responsible for their own travel and lodging cost.

*You will need a credit card to reserve your hotel room.*


Please mail registration payments to:
Western Tribal Diabetes Project- NPAIHB
2121 SW Broadway Suite 300
Portland, Oregon 97201

For questions contact:
Email: wtdp@npaihb.org
Phone: 503-416-3257

T