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    Registration Form 


    Date: Saturday, April 27
    Place: Fury Lecture Hall of the Prusmak Center 
    Time: Registration begins at 8 am
    Cost$25 with online registration
    On site registration fee is $30


     

    Name  
       
    Title  
       
    Institution  
       
    Address  
       
    City, State, Zip  
       
    Telephone  
       
    Email  
       
    Are you a student
    or faculty?
     
          
       
    If submitting an abstract please
    add it here:
    (Abstracts are
    due by April 1, 2013)

     
       
    Is this for an oral or poster presentation?
         
       
    Cost:  
    The final date for early registration is 
    April 15. After April 15, registration is on-site and costs $30

    If you prefer to pay by check please send it to 
    AnnMarie DelliPizzi, PhD c/o Dominican College
    470 Western Highway
    Orangeburg, NY 
     10962