Please print this page, complete the form, and then send it by mail or fax to Barbara Harrison, Conference Coordinator, Two Union Avenue, Saratoga Springs, NY 12866. Fax: 518 581-8306. Phone: 518 587-2100, ext. 290.

Name _______________________________________________________________________

Institutional Affiliation ___________________________________________________________

Work Phone __________________________________________________________________

E-mail _______________________________________________________________________

Fax _________________________________________________________________________

Mailing Address ________________________________________________________________

City __________________ State _______ Zip ________

Registration for the conference is $150 before January 5; $200 thereafter. Students: $75.
Payment method:

__ Visa      __ MasterCard      __ Discover      __ American Express

Credit card number ______________________________ Expiration date ________________

Signature ___________________________________________________________________

__ Check (please make out checks to Empire State College Foundation.)

Special needs due to disability ___________________________________________________

If you are a presenter, title of presentation __________________________________________

Equipment needs, if any ________________________________________________________