Register for the DSA Convention 2009

I want to register for the convention
First Name
Last Name
Address
City/State/Zip
Email Address
Phone
Cell Phone


DSA local (if representing a local)
I plan on arriving in Evanston on

I am looking for someone to share a hotel room with.
I need a place in someones home.
I am interested in serving on a convention committee.

Payment:
Registration rates:

2009 Delegate Registration Fee $200
2009 Alternate Delegate Registration Fee $200
2009 Observer Fee $200

These rates include convention materials, Saturday Dinner, coffee breaks and snacks during the Convention. Delegates and Alternate Delegates must pay the full fee regardless of when they arrive or leave the convention.

Daily rates for observers have not been set yet.
Payment method:

 Pay at the door
Pay by mail
Pay on-line with credit card (VISA or Mastercard only)

Once you have completed this form, please click the “Send Form” button below.
**IF YOU ARE PAYING ON-LINE WITH A CREDIT CARD, YOU MUST CLICK ON A LINK PROVIDED IN THE PAGE THAT FOLLOWS ONCE YOU HAVE SUBMITTED THIS FORM. You will be sent to a separate on-line payment form.