Farmworker Freedom March // April 16-18, 2010 // Registration

Farmworker Freedom March Registration

Please use this form to register for the march, whether you plan on joining us for the complete march or just a portion. Registration helps us to arrange for adequate transportation, meals, water, lodging and other important logistical needs. Thank you!

Please note: If you will be participating as part of a group, please select one point person to register everyone in the group together.

Note: If you encounter "n/a" in a field that does not apply to you, please do not erase the text as your information will not be processed if any of the boxes are left empty. You have not successfully registered until you have submitted your information and see the text "Thank you for registering!" Please contact us with any questions.

I. Contact Information
(asterisk indicates a required field)

Title

Name*

Last Name*

Organization/School/Affiliation*

Street Address*

City*

State*

ZIP*

Email*

Phone*

Number of adult participants*

Number of participants under 18*

Please fill out the following sections as they apply to you or your group.

II. March

I/we plan to join the CIW for the entire march

If yes, please skip to section III.

A. Friday, April 16

I/we plan to join you for the following (please check all that apply):

Full day (downtown Tampa to Temple Terrace) – if yes, please skip to section B
First 3 miles (gather at 9:00am; march from downtown Tampa to Ybor City)
Morning (9:00am - 1:00pm)
Afternoon (1:00pm - 6:00pm)
Home Stretch (final 3 miles on Busch Blvd.; gathering point TBA)
Welcoming of marchers/Picket (6:00pm - Publix in Temple Terrace, 5450 E. Busch Blvd.)

Yes, I/we will need a shuttle back to my/our vehicle(s)

B. Saturday, April 17

Full day (Plant City to Lakeland) – if yes, please skip to section C
First 3 miles (gather at 9:30am; march from Publix to downtown Plant City)
Morning (9:30am - 1:00pm)
Afternoon (1:00pm - 6:00pm)
Home Stretch (final 3 miles.; gathering point TBA)
Welcoming of marchers/Prayer vigil at Publix corporate headquarters (6:00pm)

Yes, I/we will need a shuttle back to my/our vehicle(s)

C. Sunday, April 18

Full day (Picket, march and rally) – if yes, please skip to section III
1:30pm Picket at Lakeland Publix (2518 S. Florida Ave.)
2:00pm March to Munn Park
3:30 Concert and Rally in Munn Park

Yes, I/we will need a shuttle back to my/our vehicle(s)

III. Meals, Lodging and Transportation

Meals

I am/we are interested in sharing meals with the CIW and other march participants for the following meals (please check all that apply):

Friday
Breakfast
Lunch
Dinner

Saturday
Breakfast
Lunch
Dinner

Sunday
Breakfast
Lunch
Dinner

Dietary Restrictions (please list)
n/a

Lodging

Please note: the CIW is working with area congregations to arrange free floor space for statewide and national participants. Though modest, accomodations will be safe.

I/we need lodging on the nights of (please check all that apply):

Thursday, April 15
Friday, April 16
Saturday, April 17
Sunday, April 18
Please list any special needs:
n/a

I/we agree to follow the CIW's leadership and respect the rules of the host congregation.*

Transportation

Air

Please make plans to fly in and out of Tampa International Airport (TPA). If you will be joining us for the entire march, please plan to fly in on Thursday evening, April 15th and out on Monday morning, April 19th. (Activities will not end in Lakeland until 7:00pm on Sunday, April 18th.)

If group members will be flying on separate flights, please send itineraries to march@ciw-online.org.

I/we will fly into Tampa International Airport (TPA) on:

Thursday, April 15
Friday, April 16
Saturday, April 17 (transportation from the airport will be provideds until noon)

I/we will need transportation to and from the airport
I/we will have my/our own transportation while in the Tampa Bay area

Airline

Flight Number

Arrival Time

Departure Date

Departure Time

Cell Phone Number

Ground

I/we will drive to the march
I am/we are interested in carpooling to the march

I/we understand that the CIW and its members are committed to non-violent social change.
I/we will respect their leadership throughout the duration of the march, and understand that there will be zero tolerance for drug or alcohol use, sexual harassment or vandalization of property.*

Additional Comments