Please complete the form and send by mail or fax before Friday, May15th.
Should you have any questions regarding registration, please do
not hesitate to contact Ms. Leasa Rochester.
Tel: 716-878-5451 * Fax: 716-878-3465 * E-mail: Rochesln@buffalostate.edu
(Please Print)
Mail payment and form to:
Networking in Higher Education Conference
Buffalo State College
South Wing, Room 100
1300 Elmwood Ave.
Buffalo, NY 14222-1095
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| Please check one: |
Faculty [__] Staff [__] Student [__] |
| Other:______________________________________ |
Name:______________________________________ |
| Title:______________________________________ |
| Institution:______________________________________ |
| Address:___________________________________ |
| City:__________________ State:_______ Zip:_____ |
| E-mail Address:___________________________ Phone:________________________ |
Registration Fees: |
|
By May 15th
|
|
$80.00 Faculty/Staff
|
|
Late Registration
|
|
$100.00 Faculty/Staff
|
|
Luncheon Only/Student Only
|
|
$40.00
|
|
| Types of Payment: (NO REFUNDS after May 15th) |
| [__] Personal check: ck # ________________________ |
| [__] Purchase order # ________________________ |
| [__] Please charge my: Visa[__] MC[__] |
| Account Number:________________________ |
| Expiration Date:_______ Dollar Amount:________________________ |
| Signature of Cardholder:________________________ |
| Fax your Visa or MasterCard Payment to: (716) 878-6100 |