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Event Registration

Name of Event (choose one)
UCLA Day in Washington D.C. UCLA Day in Sacramento
Bruin Caucus Orientation UCLA Day with Local Government
Advocacy Workshop Other event  
Please register me for: guest(s)
First Name Last Name
Title
Company
Preferred mailing address: Home Business
Address
City State Zip
Work Phone Home Phone
Fax Email

UCLA Affiliations (choose as many as apply):
Degree Holder (Major:  )
Student (Major:  )
Staff
Faculty
Community Partner
Friend
1) Please list the names of the legislators or their staff with whom you are acquainted. Use the following codes to indicate the extent of the relationship. Each relationship can have more than one code.

(A) Legislator/staff member knows me well and will answer my call personally.
(B) Legislator/staff member and I have spoken on occasion and s/he will recognize my name.
(C) I am a constituent
(D) I am a contributor
Legislator/staff member Contact Level
A B C D
A B C D
A B C D
A B C D

2) Please list any political, business, or community organization to which you belong.

How did you hear about us?
Bruin Caucus Brochure
Website
Alumni Association
Meeting and/or Event: Please specify:
UCLA Staff: Please specify:
Other: Please specify:
   
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