Annual Cooperators' Meeting Registration Form

Contact Information:

First name:    
Last name:    
Affiliation:    
Position:    
Email address:    
Phone number (work):      
Phone number (home or cell):      

I plan to give a presentation:  Yes   No

Method of presentation:  Oral   Poster   Both

Title of presentation:

Brief abstract or keywords (used to place
presentations in appropriate sessions):


NOTE: Speakers should plan for an 8-minute presentation followed by a 2-minute question and answer period.

I plan to attend lunch the first day:  Yes   No

I plan to attend lunch the second day:  Yes   No

I plan to attend the dinner:  Yes   No

I have dietary restrictions:  No   Vegetarian   Other

(Note: If "Other", please explain in the comments box below.)

Someone else will be paying my registration fee:  Yes   No

If yes, who? (Last, First) 

(Note: If you are not making a payment, you may skip to the end of this form.)


I am paying a registration fee for:
How many standard ($50)?
How many student ($25)?

If you are paying for multiple registrants, please list their names and email:
Standard names
(Last, First, Email address):
Student names
(Last, First, Email address):

I will be paying by:  Check   Paypal

I will be paying by check, and I need a receipt:  Yes   No

(Note: For online payments, please use the PayPal confirmation email as your receipt. In some cases it may take several days to arrive in your mailbox.)

Instructions for payment will appear in the next window.

Please include any further comments here:

  


If you have any questions, please email Suzanne Wapner at sw38@cornell.edu.