Please use this button to print
& submit via fax to
(202) 632-0045
National Indian Gaming Commission
Phonenix Consultation
Consultation Registration Form
Attendee Information
Name (First & Last)
Position/Title
City/State/Zip
Business Street address
Business E-mail address
**All fields are required**
NOTE: Please use a separate form for each attendee
Entity registrant represents
Tribe Information
Ext.
If you selected "Other" Please enter Agency Name here
Please use this button to submit
via E-mail (Outlook or Internet
based e-mail)
or
For further information or questions, please contact:
Tribe Name
Southwest Consultation
Route 66 Casino Hotel
Albuquerque, NM
July 20-21, 2011
Rita Homa
Executive Assistant
1441 L Street, N.W. Suite 9100
Washington, DC 20005
Phone: (202) 418-9807
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