InPDUM Convention 2009 Registration Form

NOTE: The Convention Registration Fee is $50. If you click "Submit" below it is expected that you will pay online (after you submit the form it will redirect you to a payment page).

If you want to pay by check or money order, then you should not submit this form. Instead please print this page or download and print the Word file regform.doc) and mail it in to:

International People's Democratic Uhuru Movement
1245 18th Ave. South
St. Petersburg, FL 33705

Checks are payable to "InPDUM" (please right "convention" in the memo).

Contact Your Full Name: Street Address: City: State/Province: Postal Code: Country Email Primary Phone Secondary Phone Organization (if any) Web Site (if any)

Emergency Contacts

Name Relationship Primary Phone Secondary Phone

Meals Please note that this is just a count for the chef; meals will be charged separately. Saturday Oct 2 Lunch: none fish chicken veg Saturday Oct 2 Dinner: none fish chicken veg Sunday Oct 3 Lunch: none fish chicken veg Sunday Oct 3 Dinner: none fish chicken veg

Participation I am a first time participant I would like a 1-year InPDUM Membership ($35) I will attend the "They Say Cutback, We Say Payback" March on Friday Oct 2 I am interested in joining or building the following organizations: InPDUM
AAPDEP (All African People's Development and Empowerment Program)
AISO (African Internationalist Student Organization)

Comments Any Special Needs (handicapped, childcare, etc.)