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Women's Political Leadership in Massachusetts

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* 1. What is your name?

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* 2. Will you attend Women's Political Leadership in Massachusetts: A Panel Discussion on Thursday, November 15, to be held at the University of Massachusetts Boston from 6:00 to 8:00 pm?

Yes

No

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* 3. What is your affiliation, if any?

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* 4. What is your email address?

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* 5. Do you require special accommodations to attend this event?

If so, go to http://www.umb.edu/odi/ada/accommodations/odi_request_for_special_accommodation/

Other (please specify)