TED CRUZ BIRTHER SUMMIT REGISTRATION FORM

TED CRUZ BIRTHER SUMMIT REGISTRATION FORM

A national conversation on the origins and meaning of the United States Constitution

Washington, DC; January 29-31, 2016

www.TedCruzBirtherSummit.wordpress.com

www.TedCruzBirtherSummit.blogspot.com

NAME: 

STREET ADDRESS:

CITY, STATE, ZIP:

E-MAIL ADDRESS:

ANYTHING SPECIAL WE SHOULD KNOW?

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PRE-REGISTRATION (INCLUDES BOTH DAYS) $25; NO REGISTRATION AT THE DOOR

I CAN’T ATTEND BUT HERE IS MY DONATION OF $_________ TO SUPPORT THE TED CRUZ BIRTHER SUMMIT:

PLEASE MAKE CHECK PAYABLE TO: COMMITTEE OF ONE MILLION

PLEASE MAIL CHECK, WITH COPY OF PHOTO ID (FOR ATTENDANCE) AND REGISTRATION FORM TO:

Andy Martin

Executive Director

P. O. Box 1851

New York, NY 10150-1851

(to arrive in New York before January 28th)

© 2016 Andy Martin All Rights Reserved