UCLC Banquet Sign-up

Carniglia's, Saturday, June 29th, 2002

To pay by credit card , please fill out the payment form,
print it out and send it via fax to: 607-254-4552

Frist Name:
Last Name:
Email Address:
Credit Card Type:
Name as it apears on the credit card: * if different from above
Credit Card Number:
Valid Thru (Month/Year):  mm/yy

or call Peggy Steenrod at (607)255-4951 and give her this information verbally.

To pay by check , fill in your name and email address only, print it out and mail it to: Monica Wesley, 130 Newman Laboratory, Cornell University, Ithaca NY 14853 with a check payable to Cornell University.

A receipt will be emailed to you.