Registration Form - Return by Fax or by mail.

Willow Tour on November 11-13, 2004

Name______________________________________________________

Organization _________________________________________________

Address ____________________________________________________

City _____________________ State ________ Zip __________________

Phone ( ______ ) _______________ Fax ( _____ ) __________________

email ______________________________________________________

Dietary or special needs:________________________________________

Register me for the Willow Tour on November 11-13, 2004.

Fee: $125 includes event materials, transportation for the tour, lunch and dinner on Friday and lunch on Saturday.  All other meals are on your own.

Please circle method of payment: Check (payable to SUNY Research Foundation), Credit Card (no American Express), or Purchase Order.

If paying by check, please make your check payable to: SUNY Research Foundation.

If paying by credit card, (check VISA or MasterCard below)

                              ______ Visa     _____ MasterCard     Expiration Date: ______________________

                             Name on the Credit Card: ____________________________________________

                            Credit Card Number: ________________________________________________

                            Signature: _________________________________________________________

If paying with a purchase order, PO number: _________________.

Mail form to: ESF Outreach, SUNY College of Environmental Science & Forestry, 219 Bray Hall

1 Forestry Drive, Syracuse, NY 13210-2784 or FAX: 315-470-6890