CONFERENCE REGISTRATION FORM

40th ANNUAL FALL MACUB CONFERENCE
OCTOBER 20, 2007
St. JOHNS UNIVERSITY
QUEENS, NEW YORK


Registrations should be returned no later than October 12, 2007 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 10/12
On Site
10/20
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.
2008 membership dues are included in the regular and student registration fee.


I will not be attending the Conference but enclosed is my 2008 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 12, 2007
The membership fee ($20 for regular members or $10 for student members)
will be deducted. No refunds will be given postmarked after October 12, 2007

   


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