The Creative Journey Counseling

Conference 2006

August 8^th – 10^th, 2006

at the
University of Alaska Anchorage, U.S.A.

The Swan Circle Group and its organizing committee encourage attendance at the

Deeping the Process of American Indian

Alaska Native Counseling Conference

For information on the conference please go to www.swancircle.com

Annual Conference Registration

Online Registration & Payment is available at:

Please fill in the blanks below and send your completed registration form AND payment by the listed deadlines.

Complete one form for each conference attendee

Name: E-Mail:

Address: City

State: Country: Zip: Phone:

Agency: Title:

Registration Options: All Rates listed are per person registration Total

Conference Registration--received by May 30^th, 2005 $295 $

Conference Registration--received after May 30^th, 2005 $335 $

Group (3 or more) Registration Discount - received by May 30^th, 2005 $275 $

Group (3 or more) Registration Discount - received after May 30^th, 2005 $300 $

Student Registration--received by May 30^th, 2005 $235 $

Student Registration--received after May 30^th, 2005 $250 $

One Day Participation Registration $200 $

Accommodations: Check-in date: Check-out date:

UAA Housing: Select one option from the list below) All beds are single person beds

Single Suite 1 single bed w/private bath. (Limited # availability) $50/night $

Double Suite 2 bedrooms w/ 2 single beds total & private bath $70/night

(Shared) (2) $35/night ea. $

Quad Suite 4bedrooms w/4 single beds total & 2 private baths and living area. $110/night

(Shared) (4) $27.50/night ea. $

Roommate 1: Roommate 3:

Roommate 2: Roommate 4:

Gender: M F (circle one)

If you would like to share a suite & need a roommate: (Please Check Box) & use Shared Suite rate.

* You will receive an emailed confirmation * Please list email address clearly *

Total amount enclosed: $

Payment Options:

Check # or Money Order # (Make Payable to UAA Conference Services)

Credit Card: (Please circle One) VISA MasterCard

Credit Card Number: Expiration: 3 Digit V Code

Other Type of Payment:

Sending Options

Mail Registration to: UAA Conference Services

P.O. Box 141606

Anchorage AK 99514-1606

Attn: The Creative Journey Counseling Conf 2006

Or Fax: (907) 751-7377

Or E-mail: tinav@uaa.alaska.edu

Or Phone: (907) 751-7211

Questions?

Conference Registration or UAA Guest Housing:

Tina Veldkamp 907-751-7211 tinav@uaa.alaska.edu

Programs:

Josh Thom 602-954-1518 joshthom1@hotmail.com