2017 WiLL/WAND National Women's Leadership Conference Registration Form
Title *
Name *
Your answer
Preferred Mailing Address (including city, state, and ZIP) *
Your answer
Email Address *
Your answer
Mobile Phone Number *
Your answer
Home Phone Number
Your answer
Twitter Handle
If applicable
Your answer
Name of your U.S. Representative in the United States Congress *
Your answer
The WiLL/WAND Conference includes a Lobby Day on Tuesday, October 3. Participants will be meeting with their Representatives in the U.S. House of Representatives and U.S. Senators. Please check the appropriate boxes below. *
Emergency Contact Information *
Please include Name, Relationship, Phone Number, and Address.
Your answer
Please specify any health concerns that we need to be aware of below.
Your answer
Please indicate any special needs that we need to be aware of below.
I would like to request a travel and lodging scholarship. *
WiLL/WAND provides limited travel and lodging scholarships to attend our conferences and trainings. We are happy to announce that registration fees for first-year legislators are waived. Scholarships cover hotel accommodations (shared room), as well as air travel or mileage reimbursement up to a maximum of $350. Please note scholarships do not cover the following: checked baggage fees, meals or drinks on flight or prior/after the meeting times, transportation between your home and airport, transportation between the airport and conference site, parking fees at your home airport, and flight change fees.
Do you have any dietary restrictions we should be aware of when planning meals? If yes, please specify. *
WAND will be providing lunch and dinner on Sunday, October 1; breakfast, lunch, and dinner on Monday, October 2; and breakfast and lunch on Tuesday, October 3.
Registration Fees *
I would like to pay registration by: *
Please check the appropriate box for preferred payment method.
We will contact you to confirm registration, hotel, and travel details. Thank you!
The 2017 WiLL/WAND Conference will take place October 1 - 3, 2017
Washington Court Hotel
525 New Jersey Avenue NW
Washington, DC 20001

If you need lodging, please contact Samantha Blake (sblake@wand.org) to check room availability.

Women Legislators' Lobby (WiLL)
322 4th Street NE
Washington, DC 20002
Phone: 202-544-5055 ext. 1
will@wand.org | www.willwand.org

Women's Action for New Directions (WAND) Education Fund
peace@wand.org | www.wand.org

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