First Name: Last Name:

Home Address:

City: State: Zip Code:

Telephone: Email Address:

Are you Native American? Yes No

If YES, what is your tribal affiliation?

If NO, what native person attending the gathering is sponsoring you?
(Non-native spouses are WELCOME!)

Are you an Elder? Yes No

Are you a Youth (age 18 - 25)? Yes No

Click on the Native American skills that you have or are interested in:
(Only one can be slected. In the "Other" box please type in addtional interests)
Drum Powwow Songs Stomp Traditional Chef Crafts Hand Games

Other (please specify):

Do you have any special skills or abilities to contribute?
Yes No
If YES, please list:

Will you be performing in the Talent Show?
Yes No

Will you be assisting with the Traditional Meal?
Yes No

Do you have any medical or dietary restrictions? (Please note that the camp facilities have limited handicap accessibility)
Yes No
If YES, please explain:

Emergency Contact Name: Phone Number:

Where will you be staying?
RV Tent Semi-Private Cabin*
I arrive on (mm/dd/yy & time): and depart on (mm/dd/yy & time):

I, the undersigned, understand and agree to release the Montana Two Spirit Society, FDH & Associates, their members and officers, designated assistants, other attendees, affiliated groups and persons, and all Tamaracks Resort personnel from any and all liability including all degrees of physical and/or mental injury, property damage, loss, or theft that may be incurred as a result of my attendance at the Montana Two Spirit Gathering. I understand and accept that attendance is purely at my own risk. I agree to the strict no drug or alcohol rule and realize that I may be asked to leave if I violate this policy. I understand that local, state or national media outlets may be present during the Gathering and that my name or contact information will not be given to reporters unless authorized by me. I have filled out this form fully and completely to the best of my knowledge.

The Montana Two Spirit Society requests that a suggested donation of $25 - $150 to help cover expenses be included with your application. Donations must be either check or money order and made out to FDH & Associates. A limited number of work scholarships are available. Elders, youth, transgender, women, disabled persons, or persons on limited incomes are encouraged to apply.

Electronic signature (type name in full CAPS): Date (mm/dd/yy):
* Note: FDH & Associates will assign cabins based on availability.

To cover my cost for lodging and meals, I will be sending a check/money order in the amount of:

Other additional comments: