Centennial registration

Centennial registration form

Directions:

Fill out form below and click submit button.
After you click the submit button, you will be taken to a page where you will find instructions for paying by check or by credit card via secure server.
Please note your payment total. You will need to know it to make payment.
Questions? Contact Polly E. Holmberg: peh58@cornell.edu or 607-255-2131.
Accommodations for persons with disabilities may be requested by contacting us by May 28 to ensure sufficient time to make arrangements. Requests received after this date will be met when possible.

First name:
Last name:
How do you want your nametag to read?:
Firm/Affiliation:
Address:
City:
State/Country:
Postal code:
Phone:
Email:
Tell us about any special requirements that you have:
Number of adults attending @$150 each:
T-shirt size:
	One T-shirt is included with each adult registration. Indicate S, M, L, and/or XL. (Adult sizes.) Order additional T-shirts below.
Number of children 12 years or under attending @$20 each:
Registration fee:
	Number of adults x $150 + Number of children x $20
Optional: Please use the section below if you want to order additional T-shirts and books.
Number of additional T-shirts:
	One T-shirt is included with each adult registration.
Total cost of additional T-shirt(s):
	Number of T-shirts x $15 each
Size(s) of additional T-shirt(s):
	Indicate S, M, L and/or XL. (Adult sizes.)
Number of additional copies of history:
	One copy of "150 Years of Botany at Cornell; 100 Years of Plant Biology in CALS" is included with each adult registration.
Total cost of additional copies of history :
	Number ordered x $15 each
Continue your registration: Add registration fee and cost of additional T-shirts and books and enter in box below. Please remember your total. You'll need it after you click submit button below and go to payment page.
Enter total cost: