Camp Millie Registration

All fields marked with an asterisk (*) are required fields. You can now pay your registration fee online. Upon completing this form you will be prompted to pay your registration fee using PayPal. If you choose not to pay online, our staff will contact you to finalize payment for the event. The Justice Caucus does not provide transportation or housing for participants. Please make your own arrangements.

Camp Millie Event: *

2-Day Camp Millie Northern Michigan at Black Lake ($50)

Other Future Event

Full Name: *

Street Address: *

Apt/Bldg/Suite:

City: *

State: *

Zip Code: *

Phone Number: *

include area code and extension, if any

Alt. Phone:

include area code and extension, if any

Email: *

I am a/an: *

Activist

Candidate

Campaign Staff

(Select all that apply)

Candidate for Office:

If you are a Candidate, please specify office you are seeking and the year in which the election will take place.

Preferred Contact Method: *

Email

Phone

Alt Phone

Vegetarian:

I am a vegetarian.

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