Fall Language Feast Member Registration form 2024

Full Name*

First NameLast Name
Community*
Title/Position*

Youth (Age 18 and under)ElderEducation DirectorLanguage TeacherChief or Council memberLanguage EnthusiastChaperon (only if you are taking a youth under 18)
Anishinaabemowin Fluency Level*

First Language SpeakerAdvanced LearnerIntermediate LearnerBeginner
Phone Number*
E-mail*
example@example.com
Age*
If the participant is under the age of 18, please provide the name of the adult accompanying the youth.
The hotel room will be registered under the adult's name, and the mileage will be provided to the adult accompanying the youth.
Accommodations needed*

Yes, 1 bedYes, 2 bedsYes, no preferenceNo
*We will make every effort to accommodate your request; however, it will be subject to availability and assigned on a first-come, first-served basis.

Bimose Tribal Council will cover the cost of meals, travel and accommodations for 4 Youth (18 & under), 2 Language Speakers, 1 Language Teacher and 1 Education Director or designate from each of the Bimose Tribal Council Communities.

All other participants will be responsible for their own costs meals, travel and accommodations

I acknowledge by signing this form, that I will be responsible for any damages that may occur to the hotel rooms during my stay.
Mailing Address*

Address

Address Line 2

CityState / Province

Postal / Zip Code
Sweater Size*
Allergies or Medical Information:
Please list any Allergies, dietary restrictions or medical information organizers need to be aware of.
I, blanks* hereby grant permission to Bimose Tribal Council and all Conference sponsors to use any photographs, video and/or audio taken of the registered participant on February 8 & 9, 2025 during the Anishinaabemodaa Conference at the Delta Hotel, in Winnipeg Manitoba, in any publications, news releases and communications.
Signature*

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*Signature of Parent or Guardian, if participant is under the age of 18
Date*

MonthDayYear
Date
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