Registration Form for

YDS Summer National
Conference & Activist Retreat
August 12-14, 2005
Lamont Castle - Ossining, New York

Full registration includes all three days plus:

Please complete the information below...
Cost (check all that apply):
$50 Special pre-registration Rate (payment must be made online or postmarked by Friday, July 15th)
$75 regular registration rate
$100 solidarity rate (extra funds will go towards travel scholarships for low-income individuals)
$150 bonus solidarity rate (like the solidarity rate, only you get a free t-shirt or poster for your extra financial support)
$10 YDS Membership - Special Conference Rate
I have special financial circumstances and can't pay the above prices
Housing accommodations:
Housing accommodations will be provided at the Lamont Castle for Friday and Saturday night. Please notify us if you also need housing for Thursday and/or Sunday night. Conference goers are asked to bring their own sheets, pillows and/or sleeping bags (there are several dozen mattresses available at the Castle). Please remember to bring towels, toiletries and other items (like flashlights, sunscreen, bug-spray, etc.) to make your stay comfortable. For those of you who prefer to stay in a nearby motel, we will provide you with information about less rustic accommodations if you check the box below.
TYPE OF HOUSING (Check all that apply)
I need free housing at the Castle
I can afford and prefer to stay at a nearby motel
I do not need housing (live nearby and not staying overnight)
I also need housing for Thursday night (August 11th)
I also need housing for Sunday night (August 14th)
Travel subsidies:
Some financial assistance to cover travel expenses may be available to registered participants. Preference is given to Young Democratic Socialist members and those interested in starting YDS chapters.

I would like to request travel subsidies
I am coming from (list location)
My estimated cost of travel is (enter amount)
Enter your information:
First Name
Last Name
Email Address
Address
City/State/Zip
Phone
School (if applicable)
Graduation Date (if applicable)
Organisation (campus, community, and/or union)
Age
YDS Member?
(check all that apply)
 Yes No Thinking about joining
Interested in starting a chapter
How did you first find out about the conference? YDS Website
CampusActivism.org
Listserv
Flyer
Friend
other
What are the issues that most interest you?:
Please enter additional comments or questions below:
Payment method:
(the $50 special pre-registration rate is only available if paid on-line or post-marked by July 15th)
Pay at the door (not good for pre-registration discount)
Pay by mail
Pay on-line with credit card (VISA or Mastercard only)

Once you have completed this form, please click the “Send Form” button below.
**IF YOU ARE PAYING ON-LINE WITH A CREDIT CARD, YOU MUST CLICK ON THE LINK PROVIDED IN THE PAGE THAT FOLLOWS ONCE YOU HAVE SUBMITTED THIS FORM. You will be sent to a separate on-line payment form.