2020 State Convention Delegate Registration Form
May 23-24, 2020
Sheraton Waikiki
2255 Kalakaua Ave
Honolulu, HI 96815
I am a.... *
First Name *
Your answer
Last Name *
Your answer
Preferred Name
Your answer
Residential Address: Number ONLY (No PO Boxes) *
Your answer
Residential Address: Street Name (No PO Boxes) *
Your answer
Residential Address: Apt Number ONLY
Your answer
Residential Address: City (No PO Boxes) *
Your answer
Residential Address: State (No PO Boxes) *
Residential Address: Zip Code (No PO Boxes) *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
I have submitted my VOTER/CANDIDATE PLEDGE OF SUPPORT FORM (due by May 7, 2020 @ 5pm in order to be eligible to vote for National Delegate Candidates)
Registration and Other Fees (An ActBlue Link will be provided to you for payment upon completion of this form)
Special Assistance Needs: If you require special assistance or auxiliary aids and/or services to participate in the convention (i.e. sign language interpreter, wheelchair accessibility, or parking designated for the disabled), please advise of the assistance required so that arrangements can be made.
Your answer
Tuition Assistance: If applying for a full or partial waiver of registration fees, please submit this form and attach a written explanation that describes the amount of the tuition waiver needed, your basis for financial need, and your willingness to volunteer to help with convention work. Requests must be received by the DPH no later than May 7, 2020 at 5:00pm.
Your answer
Choice of lunch *
Certification
CANCELLATION: If a convention reservation is cancelled prior to May 7, 2020, the delegate will incur a $50 processing fee. There will be no refund of registration fees for cancellation of registration after May 7, 2020. Refunds may be issued after the state convention has closed their books, unless otherwise directed by the Party Chair. By typing my full name and date below, I certify that I understand the cancellation policy, and that I am the person listed on this form. *
Your answer
NOTICE: This solicitation is made on behalf of the Democratic Party of Hawaiʻi (DPH) for both its state and federalcampaigns. Contributions to the Federal Account, combined to the state, county, and local Party committees, are limitedto $10,000 per year from individuals and $5,000 per year from qualified Federal PACs, and will be used in federal andstate activities. Contributions from corporations, labor unions, and federal government contractors are prohibited in thefederal account. Contributions from individuals and entities are limited to $25,000 per year to the Non FederalAccount. Contributions from foreign nationals and contributions made in the name of another are prohibited in bothaccounts. Contributions are not tax deductible. Federal and state laws require us to use our best efforts to obtain andreport the name, mailing address, occupation, and employer of our donors.
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