29th Annual International Two Spirit Gathering and First Annual Texas Gathering

Required: Read this before proceeding with this form.

Note: If you need to make changes after submission, just fill out the form again and State that "This is an Edit to a Previous Submission" in the Suggestions Box at the Bottom of the Form, or contact a Committe Member so that we can edit the form submission. We understand LIFE happens.

Further Note: We will be contacting you if any of your answers require us to help you out (e.g. pickup from airport, etc.). If you have any questions please contact our president at barry.layton@texastwospirits.com or a fellow Gathering Committee Board Member.

For EMERGENCY Purposes only, Contact Barry Layton at 214-934-0164, unless you have been given this number aside from this form.

Registration fee of $100 USD (NON REFUNDABLE) for the Entire Gathering is Required to attend. All Necessary Expenses while you are at the gathering will be covered including lodging. Scholarships and Hardship Funding are both available!

Full Name*

FIRSTMIDDLELAST/SURNAME

Address*

Street Address

Street Address Line 2

CityState / Province/Region

Postal / Zip CodeCountry

Phone Number (Add Country Code In Address)*

Area CodePhone Number

E-mail*

Emergency Contact Name And Contact Info (Phone preferred)*

Date Of Birth*

MonthDayYear

Are You Native American (Native To The Western Hemisphere)? (not a requirement to be)*

YesNo

If You Are Not Native American Who Will Be Sponsoring You? (Required)

Ethnic Background Including Tribal Affiliations

Have You Been To A Two Spirit Gathering Before?*

YesNo

How Will You Be Getting To The Gathering?*

Vehicle (car, truck, RV, etc.)Plane [Closest Commercial Airports: Tyler (TYR), Longview (GGG), Dallas (DAL & DFW)]Bus (Greyhound/MegaBus, etc)Train (Amtrak, etc)Pedestrian/Biking/etcPLANES, TRAINS, AND AUTOMOBILES!!!!

Where Will You Be Staying?*

Shared Hotel Rooms (on property, limited space available)RV (hookups available)Camping/Tent/Tipi (Bring Your Own or Borrow Someone's)Offsite Lodging/Someone's Home

NEXT TWO FIELDS Are For Those Who Request Shared Hotel Rooms Only.

Check All That Apply (All will be taken into consideration on room assignments)

I'm ok with sharing a bed providing.... (Note in request box below)I require a bed to myself. (Health or Personal)I am comfortable sleeping on the floor. (Be prepared to bring what you need to sleep; e.g. sleeping bags/cots if supplies aren't available)I will be brining my dog or cat ($75 USD Fee and specify dog and/or cat in request box below)I am allergic or refuse to room with dogsI am allergic or refuse to room with cats

I Request To Be Rooming With The Following Persons (If enough are in a group we will try to assign the same room/building)

If Staying On Property But Not Staying In A Room

I Will Be Bringing My Dog ($75 USD Fee)I will Be Bringing My Cat ($75 USD Fee)

Do you Have Dietary or Medical Restrictions? (If Yes Please Explain)

I require or request... (Additional Form Required)

Scholarship FundingHardship FundingHelp Finding Affordable Transportation

What Is Your Social Status?*

Youth (25 and under)Non Youth/Non ElderElder

I Would Like To Take Part In....

Traditional Potluck MealTraditional Games/Hand GamesCooking Meals (There will be a team)Teaching A Session (Crafting, Awareness, How To, etc.)Talent Show (Performing, DJing, etc.)Traditional Music (Performing, Learning, etc.)Pow Wow (Drum, Dancing, Set up, etc.)Ceremony (Conducting, Helping, Learning)Other

If Checked Anything Above, Please Specify (e.g. Traditional Potluck: Frybread and Grape Dumplings; Pow Wow: Grass Dancing)

Suggestions or topics you would like to be included in the Gathering?

When Will You Be Arriving Approximately? (If Needing A Ride From Us Please Put The Time You Will Be At Pick Up Point*

MonthDayYearHourMinutesAM/PM Option

When Will You Be Departing From The Gathering Approximately*

MonthDayYearHourMinutesAM/PM Option

Registration Total $ (including pet fees, etc.)*

Donations $

Total Amount $*

Expected Date To Be Paid In Full (no later than day of arrival)*

MonthDayYear

You Can Pay for your Registration and Donate Money on our GoFundMe site at: http://www.gofundme.com/texastwospiritspride

Or via PayPal on our website www.texastwospirits.org

Or Mail Check or Money Order to:

P.O. Box 141361

Dallas, TX 75214

All Checks and Money Orders MUST be made out to Texas Two Spirit Society

Texas Two Spirit Society is a 501(c)(3) Tax Exampt Nonprofit and is a Texas Nonprofit Organization. Donations are tax deductable starting the 2015 tax year. Contact us for a receipt at barry.layton@texastwospirits.com

BY SUBMITTING THIS FORM AND MY ELECTRONIC SIGNATURE ...

I understand that I am required to be of 18 years of age or older to attend without a legal gaurdian. (Legal exceptions may apply.)

I consent and agree to release the Texas Two Spirit Society, their members and officers/board, designated assistants, other attendees, and affiliated groups and persons, along with JLLC Properties Inc. DBA Pine Creek Country Inn, and all Pine Creek Country Inn personnel from any and all liability including all degrees of physical and/or mental/emotional injury, property damage, loss, or theft that may be incurred as a result of my attendance at the 2016 Texas Two Spirit Society Gathering. I understand and accept that attendance is purely at my own risk. I agree to the strict no drug or alcohol rule and realize that I may be asked to leave if I violate this policy. I understand that local, state, or national media outlets may be present during the Gathering, and that my name or contact information will NOT be given to reporters unless authorized by me. I have filled out this form fully and completely to the best of my knowledge.

I agree that if I am deemed to be the cause of disrupting any part of the gathering, I will be asked to leave. If deemed necessary from my disruptions, the local authorities will escort me off of the premises. I furthermore agree to act respectful and follow any requirements stated in the Texas Two Spirit Society Gathering and Meeting Rules and Powwow Etiquette (see attached/rules will be provided at the gathering in pamphlets).

I also agree that all fees are NON REFUNDABLE donations.

I agree to these terms.

Full Name and Date In All CAPS*

DEADLINE for Gauranteed Registration is 4/17/2016

All Registrations submitted after the deadline will be waitlisted.

There will be a giveaway Sunday, so please be prepared to bring something (story, or gifts, etc.).

29th Annual International Two Spirit Gathering and Texas Two Spirit Society 1st Annual Gathering (All Hosted May 20-23, 2016)