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National Jewish Democratic Council
First Annual NJDC Washington Conference
April 23-25, 2007


Fields with an * are required.
First Name *
Last Name *
Name * Name as you wish it to appear on your badge.

Work Title *
Work Organization/Company *
Home Address *
City *
State *
Zip Code *
Home Phone *
Work Phone *
Email *

All meals will be strictly kosher observing dietary laws.
Please note any dietary restrictions


Accessible Accommodations
wheelchair access
large print materials
sign language interpreters
braille materials
other (specify)


Arrival Date
Departure Date

Fees
Early Bird
Postmarked By
March 26
Postmarked After
March 26
Full Conference (includes all meals and sessions)   

           
$375 $425
Student Registration

$125 $125
Onsite registration, add $25 to the fee


Payment Information
Make Checks Payable to National Jewish Democratic Council
YOU MUST INDICATE IF YOU ARE PAYING WITH A CHECK, VISA, MASTERCARD, DISCOVER OR AMERICAN EXPRESS
Total $
Payment Type
 
Full name (as it appears on your card) *
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If you have any questions, please email natalie@natalieshear.com.


Mail Check to:
NJDC Washington Conference
c/0 Natalie Shear Associates
1730 M Street NW, Suite 801
Washington, DC 20036
202 833-4456 x101
202 833-2116 fax