Fall Language Feast Member Registration form 2024

Full Name*

First NameLast Name
Community or Organization*
Title/Position*

Youth (Age 18 and under)ElderEducation DirectorLanguage TeacherChief or Council memberLanguage Enthusiast
Anishinaabemowin Fluency Level*

First Language SpeakerAdvanced LearnerIntermediate LearnerBeginner
Phone Number*
E-mail*
example@example.com
Age*
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
My Products*
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Conference Access- General Admission
$200.00CAD



Conference Access- Youth Age 18 and Under
$50.00CAD



SeniorAge 65 and Up
$50.00CAD



Total

$0.00CAD
Method of Payment*

ChequeEMT
Cash payments will no longer be accepted as a payment option.

EMT can be sent to anishinaabemodaa@bimose.ca

OR

Please make cheques payable to Bimose Tribal Council.

Please put "Anishinaabemodaa Conference" in the memo section

Mailing Address:

598 Lakeview Drive

Kenora, Ontario

P9N3P7

Registration is not considered complete until payment is received
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