Money and Politics - Participant Registration

To register for the Dialogue on Money and Politics, please complete the form below. The information that you provide will be used to develop a picture of the overall demographics of our Dialogue participants. Required fields are indicated with an asterisk. Only your name, e-mail address and introductory statement will appear on the project Web site.

In addition to this registration form we would like you to fill out a brief questionnaire on the topic of the upcoming Dialogue. The questionnaire will appear on your screen as soon as you complete your registration. We will contact you by e-mail to verify your registration and to provide you with notifications of updates to the project Web site. Thanks for your participation!

A. Please give us the following information about yourself.

Last Name:*
First Name:*
E-Mail:*
City:		State:*	(select state) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin
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Age:	17 or younger 18 - 29 30 - 49 50 - 64 65 or older	Gender:	female male
Schooling:	Less than 6th grade 6th - 8th grade Some high school High school graduate Some college College graduate Graduate school	Ethnicity:	African American Asian American Hispanic Native American White Other

B. Please tell us about your involvement with this Dialogue and with other NIF Forums.

1. How did you hear about this Dialogue?

E-mail announcement From a friend or colleague Newsletter article Posting on a Web site Announcement in the media Other

2. If you learned about the Dialogue through an organization, please give its name below.

3. In how many National Issues Forum events have you previously participated?

None 1-3 4-6 7 or more Not sure

C. In three or four sentences please tell us something about yourself and why you are interested in the topic of Campaign Finance Reform.