AAPC - ACADEMIC OUTREACH CONFERENCE REGISTRATION
Student: $20
Consultant: $100
Academic: $100
Other: $100
Are you a member of the American Association of Political Consultants? Yes
No
Student scholarships and academic group rate packages are available on a first-come, first-serve basis. For more
information go to http://www.uakron.edu/bliss/blissConf.php.
Name: __________________________________________________________________
Affiliation: ______________________________________________________________
Address: ________________________________________________________________
City: ____________________________ State: ______________ Zip: ______________
Telephone: ______________________________________________________________
Party Affiliation:
Democrat
College Level (Students only):
Republican
Freshman
Independent
Sophomore
Area of Interests/Expertise (Please check all that apply):
Direct Mail
Fundraising
Internet/Technology
Polling
General Strategy
Other: ____________
Junior
Grass Roots
Senior
Graduate Student
Media
Other: _____________________________________
Payment Method:
Check (Make payable to Bliss Institute)
Credit Card (provide information below)
Card Number: __________________________________ Expiration Date: ___________
Name on Card: ___________________________ Signature: _____________________
Billing Address of Card (if different than above)
Name: __________________________________________________________________
Address: ________________________________________________________________
City: ____________________________ State: ______________ Zip: ______________
Please return this form with payment by September 28, 2007, to:
Bliss Institute, The University of Akron, Akron, OH 44325-1914