I will attend the Aug. 4 Noche Cubana Party & Celebration in Los Angeles

Please fill out this form if you will attend ANSWER's Aug. 4 Noche Cubana Party & Celebration in Los Angeles. There will be music, dancing, food, drinks, films and much more. July is the anniversary of the Moncada Rebellion and this year, 2012, is the 53rd anniversary of the Cuban Revolution. Join us to celebrate Cuba!

*1.

Question - Required - I'm coming to the Aug. 4 Noche Cubana Party & Celebration.

*2.

Question - Required - Total number of people coming (including you)

3.

Please complete the following:

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Name:

First Required	Last Required

*

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

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Phone Number: Required

Date of Birth:

If you respond and have not already registered, you will receive periodic updates and communications from PEP.

4.

Question - Not Required - Please list any organizational or trade union affiliations you have, and if you are a student, what school you attend.

(Maximum response 255 chars, approx. 5 rows of text)

5.

Question - Not Required - Please check all that apply

	I will donate to ANSWER to help its Cuba work.
	I will donate Cuba/Latin America related items to be auctioned and raffled at the Noche Cubana.
	I volunteer to help build the Noche Cubana.
	I want to get involved with ANSWER's Cuba solidarity work.

Click here to pay your $10 entrance fee for the July 30 Noche Cubana Party & Celebration (or make a donation to ANSWER's Cuba work).

Click here to purchase $5 raffle tickets to win an iPad 2 ($500 value).

6.

Question - Not Required - Comments:

(Maximum response 255 chars, approx. 5 rows of text)

Noche Cubana 2012

I will attend the Aug. 4 Noche Cubana Party & Celebration in Los Angeles