PSLweb: Survey - Register for Nov. 21 Socialism Conference in Los Angeles

Register for Nov. 21 Socialism Conference in Los Angeles

1.

Pre-register for the Socialism Conference in LA by filling out this form.

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First Name: Required

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Last Name: Required

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Email: Required

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Street 1: Required

Street 2:

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City: Required

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State / Province: Required

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ZIP / Postal Code: Required

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Phone Number: Required

Occupation:

Date of Birth:

Month

Day

Year

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?

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?

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

Register for Nov. 21 Socialism Conference in Los Angeles

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