Printable Registration Form (pdf format) - Osage Nation

REGISTRATION NOW OPEN
5 th Annual Preparing for the 7 th Generation:
The Journey Continues
April 17, 18 and 19, 2012
Reed Conference Center
Midwest City, OK
Sponsored by:
Cherokee Nation, Cheyenne and Arapaho Tribes, Chickasaw Nation, Choctaw Nation,
Muscogee (Creek) Nation, Osage Nation, Oklahoma City Area Inter-Tribal Health Board,
OU School of Community Medicine, Oklahoma State Department of Health,
Oklahoma Tobacco Research Center, American Legacy, American Heart Association
Keynote Speakers:
Tuesday, April 17:
Wednesday, April 18:
Jonathan Orens, MD
Professor of Medicine
Chief of Division of Pulmonary & Critical Care Medicine
Johns Hopkins Hospital
Cynthia Hallett
Americans for Non-Smokers Rights
Tim Milbrandt
Mayo Clinic
Thursday, April 19:
Dr. Terry Cline
Commissioner of Health
Oklahoma State Department of Health
Kevin Collins
Centers for Disease Control and Prevention
REGISTRATION FORM ATTACHED

CONFERENCE REGISTRATION FORM
Conference Location:
Reed Conference Center, 5800 Will Rogers Rd., Midwest City, Oklahoma
REGISTRATION IS FREE
PLEASE COMPLETE ONE REGISTRATION FORM PER PARTICIPANT
Please check the dates that you plan to attend:
April 17___ April 18 ___ April 19 ___
Name: ____________________________________________________________________
(Please print legibly)
Organization/Tribe ________________________________________________________
Address: __________________________________________________________________
City, State, Zip Code: _______________________________________________________
Telephone: ______________________
Fax: ____________________
E-mail:
_________________________________________________
Please let us know if you have any special needs:
__________________________________
To Register, please mail, fax or e-mail completed form to:
Linda Robertson
Office of Tribal Liaison
1000 N.E. 10 th St.
Oklahoma City OK 73117
Phone: 405/271-9444 EXT 56420
Fax: 405/271-1225
Email: lindaj@health.ok.gov
To Book Lodging:
Sheraton at Reed Center (405/455-1800
Or copy and paste the following link into a web browser
http://www.starwoodmeeting.com/StarGroupsWeb/res?id=1201190271&key=6994D