Montana Gay Men's Task Force

MONTANA & INTERNATIONAL TWO SPIRIT GATHERING REGISTRATION - July 26 - 29, 2012
(Confidentiality Ensured)

Number of registrations limited to 75 due to space at the ranch

Please complete the following electronic registration form as thoroughly as possible. Make sure you hit the "submit registration" button at the bottom of the electronic registration form. DO NOT HIT ENTER. INSTEAD TAB OR CLICK TRHOUGH THE FIELDS (Hitting enter will submit your registration form prematurely). You will be contacted shortly (within 2 - 3 business days to confirm your regsitration). Registration deadline is July 13th, 2012.

Please send your registration fee to:
Montana Two Spirit Society
P.O. Box 7514
Missoula, MT 59807

If you have any questions regarding this registration or about the Two Spirit Gathering, please call 406.829.8075 or email: fdh@mtgayhealth.org

CLICK HERE! If you are interested in a Scholarship for this Gathering.
(A limited number of scholarships are available. Up to 25 scholarships are available and will be approved by the committee)

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* (Cabins & Lodge limited to 40 participants)
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 Blacktail Ranch 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 & International 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.

Registration fees are $175 (US). Early bird registration is $125 if received by June 30th. Registrations must be either check or money order and made out to MT Two Spirit Society. A limited number of work scholarships are available. Elders, youth and women are encouraged to apply for scholarships.

Electronic signature (type name in full CAPS): Date (mm/dd/yy):
* Note: the Montana Two Spirit Society 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:

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