2017 MA Democratic Party Convention Registration Fee Waiver
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Last Name
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Street Address *
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City/Town *
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Ward
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ZIP *
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Email *
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Phone *
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Paying the full fee to the 2017 Democratic Party Convention would be a financial hardship. I am requesting: *
If Partial, please specify the amount you can pay
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Includes adults and dependent children
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My family income is per year *
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Other circumstances to be taken into consideration:
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Date: *
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