American Leadership Conference – Washington DC To register, please fill out the form below. Asterisk (*) means requiredName* Honorific First Last Title*Organization*Email* Phone*Are you a paid UPF member?*YesNoPayment Method:*OnlineBy Check ($25, on-site registration)Checks are payable to: Universal Peace Federation Mailing address: 3600 New York Ave., NE, Washington, DC 20002 Event Fee (Per Person)* Price: $20.00 Event Fee (Per Person)* Price: $25.00 Event Fee (Per Person) - Discounted for Paid Members Price: $10.00 I want to make additional donation: Add a Registrant Name* Honorific First Last Title*Organization*Email* Phone*Event Fee (Per Person)* Price: $20.00 Event Fee (Per Person)* Price: $25.00 Add a Registrant Name* Honorific First Last Title*Organization*Email* Event Fee (Per Person)* Price: $20.00 Event Fee (Per Person)* Price: $25.00 Add a Registrant Name* Honorific First Last Title*Organization*Email* Event Fee (Per Person)* Price: $20.00 Event Fee (Per Person)* Price: $25.00 Total $0.00 Payment by Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name Cardholder Email* Cardholder Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code