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Personal Information
First Name*
Last Name*
Email*
Address 1*
Address 2
City*
State*
Zip*
Home Phone
Cell Phone
Organization or School Affiliation:
Where did you hear about MAPS?
MAPS Involvment
I plan to attend the Lobby Day on Monday, April 14th.
I would like to serve as a community/organization/campus recruiter.
I would like to lead a community breakout strategy session
Please contact me with other opportunities for involvement in planning MAPS.
Housing
I am able to provide housing in the Boston area for out of town attendees
Explain available housing:
Fee Waiver
I would like to apply for a fee waiver.
Reason for fee waiver
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I am providing housing
I have limited financial means
Demographic Information
The following information is entirely optional, but will provide us with valuable demographic information.
Age
Gender
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Male
Female
Religious Affiliation
Race/Ethnicity
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Non-Hispanic White
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Other
Politican Affiliation
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Group Registration
Register 4 or more friends and save $5/person!
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Lobby day?
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Register early to save!
Early Registration
January 1-February 28
$10.00
Regular Registration
March 1-April 06
$15.00
Late Registration
April 07-April 14
$20.00
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