Florida GLBT Democratic Caucus

Home

Please fill out the form below to register for the conference. Please note you may also use the form if you wish to register for just the Saturday Fundraising Reception with National Stonewall Democrats or the Pinellas DEC dinner, both of which have a separate price.

First Name
Last Name
Street Address
City
State
Zip Code
Best Phone Number	Cell Home Work
Email Address
I will be attending:	Friday night reception Saturday breakfast Saturday lunch Saturday conference Saturday Fundraising Reception Pinellas DEC Dinner Sunday Brunch
I am interested in attending these workshops (please indicate your interest to help us finalize our conference offering):	Interactive Technology Chapter Development Candidate Development Chapter Legal Consideration PAC Formation Community of Faith Interaction Keeping Elected Officials Supportive Voter Registration and Strategies Using VoteBuilder Effectively
Other Attendees name(s): (if you are registering more than one person)
Notes, Special Instructions (please use this space for any brief notes, special requests or questions/information about your registration fee)
Please check this box if you wish to pay your registration fee by check. Please print this form to include with your check before clicking the SUBMIT button. PLEASE NOTE THAT PAYMENTS BY MAIL MUST BE RECEIVED BEFORE 2/19/10 OR THE REGISTRATION WILL BE CANCELLED.	Pay By Check

NOTE: Registration fees will increase after 2/19/10.

When you click the SUBMIT button you will be taken to our Pay Pal payment page. Please be sure to click the submit button, even if you are paying your registration fee by check, so that we will receive electronic notification of your registration.

If you are paying your registration by check, please mail a copy of this page and your check to:
Florida GLBT Democratic Caucus
PO Box 7492
Fort Lauderdale FL 33338-7492

If you have any difficulties, please email us by clicking here.