Great Lakes Research Consortium
Student/Faculty Conference

Please complete and mail or fax to the Great Lakes Research Consortium, SUNY ESF, 253 Baker Lab, Syracuse, NY 13210.

Name ___________________________________________

School or affiliation________________________________

Street___________________________________________

City, State/Province_________________________________

Zip___________ Phone__________________________

Email_________________________________________

Arrival Date: _______________ Departure :____________

I will be attending the banquet on Friday: yes or no
I will be attending the lunch on Saturday: yes or no
I request a vegetarian meal: yes or no

FEES: All fees are in U.S. Dollars and include the banquet on Friday and luncheon on Saturday. Preregistration. Registrations received after March 6 will be subject to a $10 late registration fee.
Faculty of Consortium institutions.........$100 ($110 after March 6)
Students of Consortium institutions......$25 ($35 after March 6)
Students Presenting..............................Free
All Others.........................................$125 ($135 after March 6)

PAYMENT: Make checks payable to SUNY Research Foundation.
Registrations paid by credit card can be faxed to us at 315-470-6970.

I will be paying by: check or credit card

Visa Mastercard Exp. Date: ____________________________

Card Number: ________________________________________________

Signature: ____________________________________________________

Copyright © All Rights Reserved