AGM 2012 Registration Form by oxP7B05n


									Thanks for your interest in the 2012 Human Rights Conference in Denver! This event will certainly be an exciting
opportunity to become reengaged with the Amnesty International USA commitment to human rights. You can look
forward to networking with other activists, listening to inspiring plenary speakers, and engaging in on-site activism in the
fight for justice. Please fill in the document below to register now!

When?            The AGM is taking place from March 30th to April 1st, 2012.

Where?           The Denver Marriott City Center
                 1701 California Street
                 Denver Colorado, 80202

                                                  PLEASE NOTE!

Registration information:

Important: Do not provide the same email address for multiple registrants or some registrations
may be lost!

Disclaimer: No refunds.

To mail your check or money order, just print out this form, fill out the information, and mail to:

Joel Alter
Member Services
Amnesty International USA
5 Penn Plaza 16th floor
New York, NY 10001

Please make all checks payable to Amnesty International USA.

Any questions? Please email us at

                                    Registration: * required information

First Name:*                                                  Last Name:*

                                  Address Line 1:*                                               Address Line 2:

City:*                                                        ZIP:*


Email: *

Registration Fees:

      Student/ Senior Citizen/ Fixed Income Member rate:                                                $   50.00

       Student/ Senior Citizen/ Fixed Income Non-Member rate:                                           $   90.00

       General Registration Member rate:                                                                $ 100.00

       General Registration Non-Member rate:                                                            $ 140.00

       Saturday Only rate:                                                                              $   50.00

Don’t forget to book a room at the Denver Marriott Hotel located at 1701 California Street, Denver CO 80202! For booking
call (303) 297-1300 or visit their hotel website. Remember to ask for the Special Amnesty International room rate of
$139/night up to double occupancy valid until February 28 , 2012!

Thank you for registering to participate in the 2012 Annual General Meeting. We
    appreciate your enthusiasm! Please take a moment to answer the following
                 questions to help us improve your conference experience:

Amnesty International USA Affiliation (please select all that apply):

Local/Student         Volunteer                    Staff                 Dues-paying             Not currently
Group member           Leader                                             member                  a member

If you selected Local/ Student Group member, please tell us your group number:

If you selected Volunteer Leader, please tell us your role:

If you are a member, please give us your membership number:

How long have you been active with Amnesty International USA?
 0 -2 years             2- 5 years             5 – 10 years            10+ years

                                                                                 Yes     No

Is this your first AGM?

Did you attend a Regional Conference in 2012?

Dietary needs: (Options – allergies, vegetarian, vegan, other):

How are you getting to the AGM? (Options- flying, train, driving, other):

Please list any People with Disabilities Act requirements or special needs. Please, direct all
accommodation needs to the hotel.

What is one thing you would like to see at the 2012 AGM (speakers, activities...)?
Please feel free to share with us what the past 50 years of AI has meant to you:

    Stay informed – Amnesty’s News and Actions:
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