CP NC Meeting Registration Form, July 7-8, 2007

Registration for CPUSA National Committee Meeting
July 7-8, 2007

Deadline for registration is Friday, June 22nd. If you do not register by 5PM June 22nd, you will be on your own for housing. No ifs, ands, or buts about it.

Full name*:
Address*:
City*:		State:	ZIP*:

District: Choose AK AL AR AZ CA-Northern CA-Southern CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN-Northern MN-Southern MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA-Eastern PA-Western RI SC SD TN TX UT VA VT WA WI WV WY	Best to reach me by: Choose Phone Email
Primary Phone*:
Secondary Phone:
E-mail*:

Arrival Date* Choose Thursday July 5 Friday July 6 Saturday July 7

Arrival Time Choose 7 AM 8 AM 9 AM 10 AM 11 AM Noon 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM Midnight 1 AM

Arrival Place Choose Driving JFK Airport LGA Airport Newark Airport Grand Central Station Penn Station Port Authority

Depart Date* Choose Saturday July 7 Sunday July 8 Monday July 9 Tuesday July 10

Depart Time Choose 7 AM 8 AM 9 AM 10 AM 11 AM Noon 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM 9 PM 10 PM 11 PM Midnight 1 AM

Depart Place Choose Driving JFK Airport LGA Airport Newark Airport Grand Central Station Penn Station Port Authority

* Yes, I need housing, please make arrangements for me.
* No thanks, I already have housing arrangements (see below).

Housing arrangements already made? If so, where?

Special needs: (like dietary, health, housing preferences)

to send to the CP Org Dept

*required fields

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