Grassroots Indian Nation Tour Registration Form
City _______________________________ State__________Zip_____________
The University of Wyoming is committed to making this conference accessible to all individuals. If you have special needs and require accommodations to participate in this activity, please let us know. You will be contacted by someone from the Special Programs Office to discuss your specific needs. ** Participants must be physically able to board & exit tour vans frequently.
|Student||$ 1,000||$ __________|
|3 Credit Hours Tuition|
|Non-Student (inclusive fee)||$1,500||$ __________|
|required immediately to ensure participation & deducted from final balance|
|Total Amount Enclosed||$ __________|
Make checks payable to UW/Grassroots Tour. Mail payment and registration
Special Programs/Grassroots Tour
P.O. Box 3972
Laramie, WY 82071-3972
To register by Phone (1-877-733-3618. ext. 3; 307-766-5634) or FAX (307) 766-3914, you must use a VISA/MasterCard, or AMEX card.
Card # __________________________
Exp. Date ________________________
Cancellation/Refund Policy: Written cancellations received before 6/15/01 will receive a full refund subject to a $35 processing fee. No refunds for no shows.