SPUSA Member?: Yes No

If "NO" what political organizations do you belong to? 
(do not leave blank- put "none" if applicable")

Address:

City:

State: Zip:

Telephone:

E-Mail:

Add my e-mail to the NOC Announcement E-List: Yes No

Special needs:

Please send your housing and travel information to us at 2008conference@socialistparty-usa.org when you have that infomration, so we can get an idea when attendees will be arriving, leaving and where they are staying.