African People's Socialist Party 5th Congress

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Your Full Name:
Street Address:
City:
State/Province:
Postal Code:
Country
Email
Phone
Emergency Contact (name, relationship, phone)
Organization (if any)
APSP Member?	Yes
Do you need to officially register your unit, branch or organization?	Yes

Organization Name
Street Address:
City:
State/Province:
Postal Code:
Country
Email
Website
Organization leader
Reports Categories of the Reports are limited to: Specific Reports from APSP organizations (InPDUM, APSC, AAPDEP, ASI AISO) Local Party Organizations/Units, organizing committees
Category of Report
Who will present report for your area

Are you currently on parole/probation?	Yes No
If Yes, please state the issue
Were you required to obtain the State's permission to attend the Congress?	Yes No
If Yes, what reason did you give?
If No, why not?
Are you required to report back?
All APSP members must sign in/out when leaving or returning during the Congress. This is for accountability and security. I agree to sign in and out.

Number of children:
Ages:
Any special needs:
Children's meals (for age 12 and under) – enter quantities
Breakfast ($5.50/day)	Sat Sun Mon Tue Wed
Lunch ($9/day):	Sat Sun Mon Tue Wed
Banquet ($25):	Sat
Children's Meal Preference	Meat Vegetarian Vegan

Congress Registration