Registration
To register for SpeakOut Illinois with a credit card, call 312-422-9300.
To register by mail, print out and fill in the form below and mail with check made payable to SpeakOut Illinois to:
65 E. Wacker Place, #800
Chicago, IL 60601
Registration is $50.00 per person if postmarked by January 19, 2009; $60.00 per person thereafter. For questions about registration, call the Illinois Right to Life Committee at 312-422-9300.
Do not use this for to register for TeenSpeak; use the separate TeenSpeak form.
NOTE: This form should print clearly using your web browser's print command, unless you are using an outdated browser. If you encounter difficulties, use our alternate registration form.
Registration Information
| Name __________________________________________________ | ||
| Address ________________________________________________ | ||
| City ________________________ | State ________ | ZIP __________ |
| Home Phone ____________________ | Work Phone ________________ | |
| Number of Guests ________ ($50.00 by 1/19/09, $60.00 after) | ||
| In addition to myself, I am paying for: ______________________________________________________________ ______________________________________________________________ |
||
| Please seat me with members of (organization) __________________________ |
||
| I am unable to attend; a donation of $_______ is enclosed. | ||
| TOTAL: $ _________ | ||
Updated 10/8/09