Days 2015 Washington, DC April 10-14, 2015

To register, please submit by Friday, April 3 . To be considered for a student travel and housing scholarship, please submit by Friday, February 27 .

______Name

Preferred name/nickname: ______

Male _____ Female ______

______Address

______City State Zip

______Phone Email address

Current Students only:

University: ______Graduation Date: ______

Congressional Appointments We will be scheduling all Congressional visits for conference participants unless otherwise requested (see below). When there is more than one participant per state or district, individuals will be grouped together.

__ Please coordinate my appointment.

__ I will make my own appointment to meet with my members of Congress. If making your own appointment, please inform Christina Ospina at [email protected] once your appointments have been scheduled.

Meals

__ I have special dietary restrictions. Please list any food allergies ( indicate severity ) and restrictions (vegetarian, vegan, etc):

Lodging Hotel Accommodations: Special rates have been arranged for Capitol Hill Days participants at The Fairfax at Hotel (2100 Massachusetts Ave., NW Washington, DC 20008), where all Capitol Hill Days sessions will be held. The rates are: $199.00/night for a superior king room, and $229.00/night for a double-bedded suite.

Reservations can be made by calling The Fairfax at at 888-627-8439. In order to receive the group rate, you must say that you are part of the Population Connection program. Unless you are receiving a student scholarship, you are responsible for payment, and must guarantee it with a credit card when making your reservation. To receive the group rate, reservations must be made by Tuesday, March 10, 2015.

Students Population Connection offers numerous travel and lodging scholarships to current students. All students will be placed in double rooms. In order to receive a scholarship, you are obligated to arrive on Friday, April 10, by the start of the first session, and stay through Monday, April 13, in order to attend lobby visits on Capitol Hill. The scholarship application deadline is Friday, February 27, 2015 .

__ Please check here if you wish to be considered for a student scholarship. Briefly state your interest in attending Capitol Hill Days.

If traveling with friends, please list two people you would like to share a room with. Roommate requests are not guaranteed, but we will do our best to honor them.

1) 2)

Submit form via: 1) Email: [email protected] 2) Fax: (202) 332-2302 Attn: Christina Ospina 3) Mail: Population Connection Attn: Christina Ospina 2120 L Street, NW Suite 500 Washington, DC 20037