Email this Print Register for Nov. 21 Socialism Conference in Los Angeles 1. Pre-register for the Socialism Conference in LA by filling out this form. * First Name: Required * Last Name: Required * Email: Required * Street 1: Required   Street 2: * City: Required * State / Province: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AS FM GU MH MP PR PW VI AA AE AP AB BC MB NB NL NS NT NU ON PE QC SK YT None State / Province: Required * ZIP / Postal Code: Required * Phone Number: Required   Occupation: Accounting Administrative, Support, and Clerical Advertising Aerospace and Defense Agriculture, Forestry, and Fishing Architecture Arts and Entertainment Aviation and Airlines Banking and Financial Services Clergy Construction and Landscaping Consulting Education and Training Engineering Environment Executive/Management Facilities, Maintenance, and Repair Fire, Law Enforcement, and Security Government Healthcare Homemaking Hotel, Gaming, Leisure, and Travel Human Resources Information Technology (IT) Insurance Legal and Paralegal Manufacturing Marketing Media Military Nonprofit Personal Care and Service Photography Property Management Psychology Publishing Real Estate, Rental, and Leasing Restaurant and Food Services Retail/Wholesale Sales Science and Biotechnology Skilled Work and Trades Social Work Stock Broker/Investment Advisor Student Telecommunications Transportation and Warehousing   Date of Birth: Date of Birth: Month Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Year 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900   Yes, I would like to receive e-mail from the PSL. (If already receiving emails from us, please leave this checked -- you will not receive duplicate emails)   Yes, I would like to receive postal mail from Party for Socialism and Liberation   Remember me. What's this? 2. Question - Not Required - How many people will be attending the conference (including you)?   3. Question - Not Required - Please list any organizational or trade union affiliations you have, and if you are a student, what school you attend. (Maximum response 255 chars, approx. 5 rows of text) 4. Question - Not Required - Will you need help finding a hotel or housing? Please select response Yes No 5. Question - Not Required - Will you need child care? Yes No 6. Question - Not Required - How many children? Please list ages in the space below. (Maximum response 255 chars, approx. 5 rows of text) 7. Question - Not Required - Do you need Spanish language translation? Please select response Yes No 8. Question - Not Required - Please use the space below to make comments or ask any questions you have about the conference or the Party for Socialism and Liberation. (Maximum response 255 chars, approx. 5 rows of text)   The Socialism Conference fee is a $7-10 donation ($5 for students). However, no one will be turned away for lack of funds.  You can also register by phone at 323-810-3380 or email at la@socialismandliberation.org.   9. Question - Not Required - Sign up to receive email updates from the Party for Socialism and Liberation Los Angeles area National updates Spam Control Text:   Please leave this field empty

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