DIRECTIVES IN AN IMPERFECT WORLD----JUNE 10, 1999
Please fill out and return this form with your check payable to:
NYCLTCEN
2975 Independence Ave.
Bronx, NY 10463
Registrations will also be accepted at the door.
CONFERENCE FEE:
$30.00 per person if received by mail before May 28, 1999.
$35.00 per person if received after May 28, 1999, including registration at the door.
$75.00 fee for three persons from the same facility.
This form may be duplicated to register additional people.
Name:______________________________
Position:______________________________
Facility:______________________________
Address:______________________________
City:_________________State:_____Zip:________
Telephone Number:______________________________
Fax Number:______________________________
E-mail:______________________________
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