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NM Children, Youth and Families Department

 

Juvenile Justice Advisory Committee (JJAC)

 

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American Indian
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Registration

There is no fee to register, however, space is limited to the first 75 people. The cut off date for registration is October 26, 2009. Registrations made after this date will be accepted as space permits.

Click here to register via fax or mail. Send the form to: American Indian Development Associates, 2401 12th St. NW, Suite 212, Albuquerque, NM 87104 or Fax to: (505) 842-9652.

To register online enter the information below and click submit. Please double check the information is correct before submitting. We will use the e-mail address provided to send your confirmation letter.



Prefix (Mr. Mrs. Ms.): *
First Name: *
Last Name: *
Title: *
Organization/Tribe: *
Address: *
Address 2: *
City: *
State: *
Zip: *
Phone: (Include area code) *
Fax: (Include area code) *
E-mail: *

If you have any special needs please indicate it in the space below.

 

 

*Required Field


 

  
       

 

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