Campaign 101 Online Registration Now Available!

Campaign 101
a grassroots activist training for high school & college students
Saturday, July 10 & Sunday, July 11, 2004
Fairfax Education Association Office
3917 Old Lee Highway, Fairfax, VA 22030

Registration Instructions Please fill out this registration form and press the send button at the bottom.  If you have any difficulties with the form, please copy and paste it into a new email and send the form with your responses to shaulaevans@comcast.net;(AOL accounts seem to have some technical problems with the webform.)

Payment Instructions The Campaign 101 registration fee is $50 per person. We do not have access to a 100% secure way to accept online payments at this time, so we are asking participants to bring the payment with them in person to the training.

Follow-up We will respond to your registration form within 24 hours. If you do not hear from us within that time, please send us an email so we can double chekc your registration status. Thank you!

Registration

First Name:
Last Name:

Address Line 1:

Address Line 2:

City: State:
Zip:

Telephone:

Email:

Emergency Contact Name: Phone: Relationship:

Meals & Accommodations

Campaign 101 will provide the following meals, included in the $50
registration fee:

Saturday:light breakfast, lunch, dinner

Sunday: light breakfast, lunch

Do you have any food allergies or dietary needs?

Please explain.

If you live in the Fairfax area, can you offer homestay accommodations to
other participants? How many?

Please supply the name and contact information for a parent so we can
coordinate the homestay details.

Name: Telephone:

Do you need us to arrange homestay accommodations for you for:

Friday night

Saturday night

Sunday night

Do you have any allergies or special accommodation needs?

Please be specific.

Additional Information

This information will help us plan for effective alumni network tools, and
also to create balanced teams for the campaign planning exercise. You don’t need
to write essays, and there are no wrong answers.

Where are you attending school in September 2004?

School: Location:
School year:

Does your school have an active Democratic club?

Are you registered to vote?

Do you turn 18 before November 2, 2004?

Please let us know about your previous experience in political clubs or
campaigns.

If the weather is good, we may offer some activities outside. Can you bring a
lawn chair?

The training may include a phone bank exercise. Can you bring a cell
phone?

What do you want to get out of your experience with Campaign 101? What are
your goals for this training?

How did you hear about Campaign 101?

Comments or Questions

Please let us know if you have other comments or questions.