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RSVP: June 29 Annual Universal Health Care Conference.
You'll still need to register for the conference and pay by June 27, but this helps us have a count for planning. Thanks!
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Out of town guests: Would your prefer to lodge in a host home, if available?
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Make sure to hit "submit" at the end, and remember to register!
Wendell Potter debunks lies re: Medicare for All
Yes I'll attend! ($40 includes continental breakfast and lunch).
Yes I'll attend and will donate to the scholarship fund so that others can attend the conference.
I'd like to attend, but will need a scholarship.
Can't be there, but support the movement for universal health care: I'll be with you in spirit!
Yes I'll attend and will offer my home as lodging for an out-of-town attendee.
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