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UCSA Student Lobby Conference 2008
Individual Registration Form

Must be filled out all delegates

Must be filled out by all delegates

Name:

Association:

Organization(s):

Position(s)/Title(s):

Phone:

Fax:

Email:

Address:

City:

State:

Zip:

Special Needs Deadline: February 8, 2008 We will do our best to accommodate but cannot guarantee special needs after the registration deadline.

Dietary needs:

Vegan

Vegetarian

Diabetic

Food Allergies (please specify):

Wheelchair Access

Large Print Materials

Childcare

Sign Interpreter

Other (please specify):

Registration Deadline: February 8, 2008
Registration must be received by the UCSA office by the deadline to qualify for the standard registration rate. Payment must be received no later than the first day of the conference, or your will be charged the late rate.

Have you lobbied before? Yes | No

Diversity Survey (optional)
Please indicate any groups with which you identify:

UCSA Student Lobby Conference 2008Individual Registration Form

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UCSA Student Lobby Conference 2008
Individual Registration Form