Online Register for 3rd Annual ILI Symposium 2012

October 22-23, 2012

Fields marked (*) are required. When finished filling out the form, please click the Next button.

Registration type*	Students must fax a copy of their school ID to 505-820-0316 Elders 65 years or older qualify for the "Elder" registration
Email Address*
Last Name*
First Name and Middle Initial*
Tribe or Affiliation
Native Language

Institute, Organization, Place of Employment*
Business Address*
City*
State/Province*
Zip/Postal Code*
Business Telephone Number*
Business Fax Number

Home Address
City
State/Province
Zip/Postal Code
Home Telephone Number*
Home Fax Number
T-shirt Size*

Registration fee is non-refundable. No exceptions.
Registration includes t-shirt and one banquet ticket. Additional banquet tickets may be purchased at the registration desk.
Purchase Orders: Send copy of PO to ILI with billing instructions and billing contact info. Once PO is received, ILI will send invoice to billing department.
Payment must be received prior to symposium to guarantee seat. Do not mail payment after October 8, 2012. Contact ILI if payment has not been processed by this date to make other arrangements.

Please verify that everything is complete, then click the “Next” button

Indigenous Language Institute
Street Address: 1501 Cerrillos Road • Santa Fe, NM • 87505 • USA
Phone: 505/820–0311 • Fax: 888/507–6658