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2009 GLRC Student/Faculty Annual Conference Online Registration Form

* REQUIRED FIELDS

* First Name, MI, * Last Name:
* Institution:
* Mailing Address:
* City, * State * Zip:
Telephone:	(include area code)
Email address:
Arrival Date:
Departure Date:
* I will be attending (please check the blank boxes)	Banquet on Friday (3/13) Lunch on Saturday (3/14)
I request a vegetarian meal

*Fees: All fees are in U.S.Dollars and include the banquet on Friday and luncheon on Saturday.
Registrations received after March 6th (Friday) will be subjected to a $10 late registration fee.

	Faculty of Consortium Institutions	$100 ($110 after March 6th)
	Students of Consortium Institutions	$25 ($35 after March 6th)
	Students Presenting	Free
	All Others:	$125 ($135 after March 6th)
	All Others: Friday only (includes banquet)	$100 ($110 after March 6th)

*Payment: Check, Cash, or Credit Card.
Sorry but we do not provide online credit card registration system for security issue, please send us your check (Payable to SUNY Research Foundation) by mail, or your VISA/MasterCard credit card information (card number, Exp.Date, and Signature) by fax at 315-470-6970. Otherwise, pay at the registration desk.

	I will be paying by check.
	I will be paying by credit card.
	I will be paying by cash at the door.