Registration Form for

TURNING THE TIDE TOWARDS FREEDOM:
Building the Youth and Student Movement for Justice

February 17-19th, 2006

Please complete the information below...
Registration:
Please note that on-site registration will be based on a sliding scale of $15 -$50.  Registration fee includes conference materials,  admission to all conference sessions, light breakfast and lunch Saturday and Sunday and admission to Saturday night Party.
$10 Special Youth & Student Pre-registration Rate (payment must be made online or postmarked by Friday, February 12th) 
$35 non youth or student pre-registration observer rate 
$50 solidarity rate (extra funds will go towards travel scholarships for low-income individuals)
I have special financial circumstances and can't pay the above prices
Join YDS:
 $10 YDS Membership - Special Conference Rate
Housing:
We will do our best to provide housing in New York City for everyone that pre-registers. We hope to have housing available for people who register the day of the conference, but can’t promise that. If you have friends or family in New York City that you can stay with please do that so that we can house people who don’t have a place that they can stay. If you have extra room and could let someone stay with you please let us know that too. Please bring sleeping bags.
TYPE OF HOUSING (Check all that apply)
I do not need housing
I can also provide housing for others with sleeping bags.
I need housing Thursday February 16.
I need housing Friday February 17.
I need housing Saturday February 18.
I need housing Sunday February 19.
Travel subsidies:
Some financial assistance to cover travel expenses may be available to registered participants. Preference is given to Young Democratic Socialist members and those interested in starting YDS chapters.

I would like to request travel subsidies
I am coming from (list location)
My estimated cost of travel is (enter amount)
Enter your information:
First Name
Last Name
Email Address
Address
City/State/Zip
Phone
School (if applicable)
Graduation Date (if applicable)
Organisation (campus, community, and/or union)
Age
YDS Member?
(check all that apply)
 Yes No Thinking about joining
Interested in starting a chapter
How did you first find out about the conference? YDS Website
CampusActivism.org
Listserv
Flyer
Friend
other
What are the issues that most interest you?:
Please enter additional comments or questions below:
Payment method:
(the special pre-registration rates are only available if paid on-line or post-marked by February 12th)
Pay at the door (not good for pre-registration discount)
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 THE LINK PROVIDED IN THE PAGE THAT FOLLOWS ONCE YOU HAVE SUBMITTED THIS FORM. You will be sent to a separate on-line payment form.