Conference Registration

CONFERENCE REGISTRATION FORM
42th ANNUAL FALL MACUB CONFERENCE OCTOBER 24, 2009 KINGSBOROUGH COMMUNITY COLLEGE BROOKLYN, NEW YORK

Registrations should be returned no later than October 14, 2009 Registration on the day of the conference will be $55. A separate form must be completed by each person attending the conference.


Personal Information
All fields are required for the registration
Title:		Name:
E-mail:
School Information
School Informanion is not required for Member's Spouse/Guest registration
Department:
School:
Address:
City:		State:	Zip code:
Phone:		Fax:
	Please check here if you do not want the information above to appear in a Directory of Members.
Home Information
All fields are required for the registration (fax field is optional)
Home Address:
City:		State:	Zip code:
Phone:		Fax:

Fee Information
	In Advance By 9/15	In Advance By 10/14	On Site 10/24
Regular Membership	$45	$50	$55
Student Associate Membership	$35	$35	$40
Member's Spouse / Guest	$35	$35	$40
All Fees include conference registration fee, continental breakfast and luncheon. 2010 membership dues are included in the regular and student registration fee.

I will not be attending the Conference but enclosed is my 2010 membership dues

Regular Membership	$20	Student Membership	$10
YOUR CONFERENCE REGISTRATION IS NOT COMPLETE UNTIL THE CORRESPONDING SECRETARY RECIEVES THE REGISTRATION FEES OR A PURCHASE REQUISITION FORM.

Please make check payable to: MACUB Send application and check to: Dr. Paul Russo Division of Natural Science and Math 467 Franklin Street Bloomfield, NJ 07003
Registration fees are refundable upon written notification by October 14, 2009 The membership fee ($20 for regular members or $10 for student members) will be deducted. No refunds will be given postmarked after October 14, 2009