Registration Form for National Conference

You can print and submit this form:

Committee of One Million to Defeat Barack Obama
Headquarters mail:
Andy Martin, J. D.
Professor of Law (Adj.)
Executive Director
Post Office Box 1851
New York, NY 10150-1851
Tel. (866) 706-2639
Fax (866) 707-2639


National Conference on Barack Obama's Missing Birth Certificate and College Records April 3-4



REGISTRATION FORM


PLEASE ENCLOSE A COPY OF A PHOTO ID WITH YOUR REGISTRATION FORM.

PLEASE HAVE A PHOTO ID AVAILABLE IF YOU PLAN TO REGISTER ON THE DAY OF THE CONFERENCE



NAME:


ADDRESS: Street:


City, State, Zip


E-MAIL ADDRESS:


ANYTHING SPECIAL WE SHOULD KNOW?



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Pre-registration (includes both days) $10

“At the door” registration (either one or two days) $25

PLEASE MAKE CHECK PAYABLE TO: COMMITTEE OF ONE MILLION

PLEASE MAIL CHECK, COPY OF PHOTO ID AND REGISTRATION FORM TO:

Andy Martin
Executive Director
Committee of One Million
P. O. Box 1851
New York, NY 10150-1861
(to arrive before March 31st)