REGISTRATION FORM
ATMNYC FALL CONFERENCE
NOVEMBER 21, 2009

To attend, please print out this form, fill it out and mail it with a check made out to "ATMNYC" to:
 

RONNI M. DAVID
16 GLORIA PLACE
PLAINVIEW, NY 11803
(TEL) 516-359-2794 (FAX) 516-935-0008
MathRonni@cs.com
 


Name ___________________________________________________________________________

Address _________________________________________________________________________

Telephone # ______________________________________________________________________

City/State/Zip _____________________________________________________________________

Email  ___________________________________________________________________________

School  __________________________________________________________________________

Level ___________________________________________________________________________

School Address ___________________________________________________________________

School Tel # ______________________________________________________________________

Position __________________________________________________________________________


ATMNYC Members: $20      Non-Members: $25     Full-Time Students: $10