Fifth Annual Freedom of Choice Ohio Lobby Day
April 21st, 2010
9:30AM - 4:30PM
YWCA
65 S. 4th Street
Columbus, OH 43215
REGISTRATION IS NOW CLOSED. PLEASE DO NOT USE THIS FORM. LATE REGISTRATIONS WILL NOT BE ACCEPTED. FOR INFO, PLEASE CALL JAIME AT 614-221-2594
First Name
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Last Name
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E-mail
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Phone
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Home Address (to match with your legislative district)
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City
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State
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Zip
*
Which organization are you a member of? (Select all that apply)
*
AIDS Taskforce of Greater Cleveland
American Association of University Women (Ohio)
American Civil Liberties Union of Ohio
Cleveland Rape Crisis Center
League of Women Voters of Ohio
National Council of Jewish Women (Ohio)
NARAL Pro-Choice Ohio
National Organization for Women (Ohio)
Planned Parenthood
Preterm
Religious Coalition for Reproductive Choice
Women Have Options, Ohio
Coalition for Family Health member organization
Other
If you indicated Coalition for Family Health or Other, please specify your specific organization:
Lunch Options
*
Regular
Vegetarian
Vegan
Are you a current student?
*
No
Grad School
College
High School
Reservations
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Standard
$20.00
$
20.00
Early Bird (Before April1)
$15.00
$
15.00
Student
$10.00
$
10.00
Total
$0.00
$
0.00
Please type the two words
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Clicking "Submit" will take you to a secure PayPal site. Please use this site to make payment by credit card. For more information, call Jaime at 614-221-2594 or email FOCO at FOCOhio@gmail.com
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