EMILY's List

EMILY’S List Political Opportunity Program

Atlanta, Georgia  

REGISTRATION FORM

Please print and fax back to (202) 326-1415, or email to

mstephenson@emilyslist.org

_____ YES, I will attend the Training on October 9^th & 10^th in Atlanta, GA

_____ NO, I am unable to attend.

Name:__________________________________________________________________

Address: _______________________________________________________________

City___________________________State___________________Zip______________

Office phone: ____________________Home phone: __________________________

Fax number*:  ____________________Cell phone:____________________________ 

Email address*:  ______________________________

*Please provide an email address or fax so we can send a confirmation and important information regarding the training.

I prefer to be contacted at: Work_______ Home______ Cell_______ Email_______

**Please clarify what office you are running for, or if you are interested in running in the future. ____________________________________________________

Please RSVP by October 1st.

Upon RSVP, further details will be forwarded.

If you have questions, please contact Michelle Stephenson (202) 419.3073 or mstephenson@emilyslist.org.