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2011 Political Planning Workshop Registration

Please complete the form below to register.

First Name (Required)

Last Name (Required)

E-Mail Address (Required)

Organization (Required)

Title (Required)

Address (Required)

City (Required)

State (Required)

Zip (Required)

Phone Number (Required)

Cell Phone (Required)

To reach you while traveling.

Dietary Needs (Required)

None
Vegetarian
Vegan
Other

Explain Other Dietary Needs

Check In

What date do you plan to check in to the hotel?

/ /

Check Out

What date do you plan to check out of the hotel?

/ /

Roommate Preference

I prefer a single room

All rooms at the hotel are double occupancy. If you prefer a single room please check the box above. We will do our best to accommodate your request, but there are no guarantees. Please note that you are responsible for half the cost of a single room. Based on our room rate, you will be responsible for approximately $80.00 per night.