General Application

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General Information
Thank you for applying to register for the People’s Summit 2017! As there are a limited number of spaces and a huge amount of interest, we are asking everyone to fill out the form below.

After you fill out the information, we'll take 7-10 days to review, and then start letting folks know if they can register or not. We are committed to diverse and inclusive participation at the People's Summit.
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* Indicates required question
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
City *
Your answer
State *
Please enter the two-letter code for your state (for example, IL for Illinois). If you are from outside the US, please enter 'XX'.
Your answer
Zip Code *
Your answer
Phone *
Your answer
Organization/Employer (consistent with your job or political work) *
Your answer
Role/Job Title (consistent with your political work/participation in the Summit) *
Your answer
If there is a contact person from one of the People's Summit affiliates that knows you, please give their name/connection here. (Not having an answer here does NOT disqualify you!)
Your answer
In order to make sure the People’s Summit is inclusive of activists and organizers from all walks of life, we offer some discounted tickets and travel stipends to our partner organizations. We ask that you pay what you are able, as the revenue from the tickets goes directly to support participants from around the country who do not have the means to fund their own tickets and travel.
If accepted, which registration level would you choose? *
If accepted, will you request a travel stipend? (Most awards are $100-$300 and are intended to ensure that everyone can attend, regardless of ability to pay.) *

Demographic information will be used to ensure that the Summit is diverse and inclusive. These questions are all optional.
What is your age?
Clear selection
What is your gender identity?
Clear selection
Do you identify as LGBTQ?
Clear selection
What is your racial or ethnic identification? (You can select more than one option)
Do you have any of the following disabilities? Check any/all that apply.
Are there any other factors or issues we should know about when considering you as a People's Summit attendee, or for receiving a travel stipend?
Your answer
If selected as an attendee, I commit to attending the People’s Summit in Chicago from June 9-11, 2017
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