Local Indian Child Welfare Advisory Committee
Retreat Registration
A Legacy of Tribal and Cultural Connections
October 6, 2015
Northern Quest Casino
100 North Hayford Road
Airway Heights, WA 99001
Email or fax registration to: Francis Cacalda cacalf@uw.edu, Fax (206) 923-4899
Name
Phone Number
Email Address
Physical Address
LICWAC Liaison
Example – Patti Nagel
Please provide the dates
you plan to stay
Example – 10/05/2015 and 10/06/2015
Willing to Carpool – please
provide nearest Park n’ Ride
location
Example – Lacey Park n’ Ride Martin Way
Please note any dietary or
other special
accommodations
Example – vegan, require a wheelchair accessible room
Notes:


Room blocks are available for October 5 and October 6. Breakfast and lunch will be
provided October 6. Dinner is on your own each night.
Mileage will be reimbursed in one of two ways:
1. Individuals will be provided with forms to complete and submit at the event.
2. Tribes and organizations who support volunteer members attending may invoice
Casey Family Programs direct after the event for actual mileage traveled.