PSLweb: Survey - Pre-register for April 25, 2009 Socialism Conference in Chicago

Pre-register for April 25, 2009 Socialism Conference in Chicago

1.

Pre-register for the conference by filling out this form.

*

Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Country: Required

Phone Number:

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)

The conference fee is a $10-20 donation. However, no one will be turned away for lack of funds.

You can also register by phone at 773-920-7590 or email at chicago@socialismandliberation.org.

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.

(Maximum response 255 chars, approx. 5 rows of text)

7.

Question - Not Required - Sign up to receive email updates from the Party for Socialism and Liberation

	Email by area > Chicago
	National updates

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)

Pre-register for April 25, 2009 Socialism Conference in Chicago

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