Please fill out the entire form and don't forget to click submit. We're looking forward to seeing you in Atlanta. Thank You! Activist's Summit Registration Form NameAddressCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip CodeHome PhoneCell PhoneEmailWill you attend the luncheon on Wednesday afternoon?YesNoWill you attend the reception on Wednesday evening?YesNoDo you require a sleeping room?YesNoArrival date (if yes)?Departure date? Share this:ShareFacebookTwitterTumblr