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UMW Action Network Registration Form

Please complete the following form to join the UMW Action Network. Click on the "Submit" button at the bottom of the page to complete your registration.

Thank you for your interest.

Washington Office of Public Policy
GBGM-Women's Division
100 Maryland Avenue, NE Room 530
Washington, DC 20002
Fax: (202) 488-5681


(* Required)  
First Name: *
Last Name: *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Phone Number (home):
Phone Number (work):
Fax Number:
E-mail Address: *
Conference & District:
Congressional District:
I commit myself to acting on the following issue(s). Please send me Updates and Action Alerts on (check as many as you like.

Note: To select more than one option, plelase hold the "CTRL" key as you make your selections.

*		 Please send me Updates and Action Alerts on (check as many as you like).