Center For Progressive Leadership

Register Now

Fill out the form below to register for the PA Conference for Young Progressive Leaders.

When you have finished your registration you will receive an email confirming your registration and instructing you as to further steps.

Please note that at the bottom of the form you are asked for your method of payment:

If you are a Young People For Fellow please select that option.
If you would like to pay online now you will be charged $20.
If you would like to pay at the door the cost will be $25.
You can also select our "Refer-A-Friend Discount." If you select this option you will receive an email on how to use our "Nominate A Leader" tool. If two people you nominate using this tool sign up before March 20th you will be admitted free of charge. If they do not sign up you will be charged $25 at the door.

If you have any questions about the registration process please email youngleaders@progressleaders.org or call Joan Javier at (617) 447-2501.

First Name		*
Last Name		*
Email		*
Phone		*
Cell Phone
Street		*
Street 2
City		*
State/Region		*
Zip/Postal Code		*

Organization
Occupation
School Attending(ed)
Graduation Year
How did you hear about this Conference?		*

Please list campus or community organizations you're involved in: *

Please describe your experience in electoral work including voter registration, voter education, get-out-the-vote: *

Why are you interested in attending this conference? What do you hope to get out of the experience? *


Please choose which training area you would like to participate in:*

How Do You Intend to Pay?*


Demographic Information (Optional) The Center for Progressive Leadership is committed to diversity in our programs, including gender, ethnic, racial, economic, sexual orientation and education. We ask that you complete these optional questions so we can assess our progress in creating a conference that matches the full diversity of Pennsylvania's communities.
Gender
Age
Ethnicity
Other Ethnicity
Income
Educational Experience