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July 4, 2009 09:27 EDT

National Convergence Registration

If you are interested in attending the National Convergence, please complete the form below. Please don't neglect to fill in your email and phone number, so that we can contact you quicker than using snail mail. It will be emailed to the organizers when you click on "Send Form" below. If you want to talk to someone about either event email ncc@seac.org, or call the SEAC office at 215-222-4711 at any hour (or Kate at 513-236-9731).

Details on the National Convergence

My Name:

What Would You Like to Attend?

I would like to attend the SEAC National Convergence
I can't make it, but please put me in touch with activists in my area
I would like to recieve a travel or registration scholarship. Read the Scholarship Guidelines to find out if you should apply

Please be aware that SEAC is very financially strapped and minimizing costs in order to keep the fee at $50 per person (pre-registration cost) to cover housing and 3 meals a day for the week. We are nevertheless happy to provide a fee waiver to those truly in need. Travel scholarships are very limited.

A Note About Scheduling

Activities begin at 9am Thursday, January 6th, so it's best to arrive at least before Wednesday night, January 5th. Activities end mid afternoon on Monday, January 10th. We'll have a place for everyone to sleep from January 4th until January 12th. If you can't make the very beginning of the convergence or stay until the very end, no problem, just let us know.

We do ask though that if you come to the first two days of the convergence that you make sure you are able to stay for all of Saturday, the 8th, and Sunday, the 9th, as that will be when we hold the anti-racism training. It is fine if you cannot make all of the rest of the convergence, as long as if you do come to part of the convergence you can come for the full anti-racism training. If this is not possible for you, contact us and we'll try to work something out.

How Are You Planning on Getting There?

I will need a ride - Don't forget to post on our ride board
I am arranging my own transportation
I have extra spaces and can give rides - Don't forget to post on our ride board
I will arrive on

I will need a ride from the Boston area I don't need to be picked up at any station.

To help us coordinate carpools, please fill out the following if you need or can give rides:

I am departing from , .
I can leave my departure city as early as ,
I am returning to , .
The latest I can get back to my return city is ,

Special Needs...

I'm Vegan
I'm Vegetarian
I can't live without meat for five days
I have a food allergy
Other:

School and Group Info

School (if any):
Type: Junior Highschool | Highschool | Community College | 4 Year College or University | Grad School
Graduation Date (mm/yy): (Important--please fill out.)
Student Group name (if any):
Community Group name (if any):

School Address info:
(This is for your address if you live away from home while at school. To fill in contact info for your activist group, click here)

My school address is the same as my home/permanent address below

Address:

Line 2 if needed:

City: State: Zip:
Country other than US and Canada? Country Name:
Phone:
Cell Phone Number: E-mail:

Home/Permanent Address info:

Address:

Line 2 if needed:

City: State: Zip:
Country other than US and Canada? Country Name:
Phone:
Cell Phone Number: E-mail:

Questions

What activist and organizing experience do you have? Have you been to any conferences/trainings before?

What do you want to get out of the National Convergence? Any specific skills? Knowledge about any particular issues/campaigns? Any kinds of connections you want to make? Anything else?

What issues (if any) are you/your group currently working on or want to work on?

How did you hear about the SEAC National Convergence? If through an email list, which email list? If from a website, which website? If through an event, what event? Etc, etc.

Comments or questions?

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