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Registration

NAME

INSTITUTION

ADDRESS


CITY, STATE, ZIP

EMAIL

Registration fees for panelists: $90*
Registrations fees for attendees: $70* or a "three-day ticket"
The fee to attend one day or one evening is $25
AMOUNT
*Registration includes Dactyl Foundation Basic-Level Membership. If you are already a member, deduct $20.

PAYMENT OPTIONS:
CREDIT CARD TYPE
MC / VISA AMERICAN EXPRESS DISCOVER

CREDIT CARD NUMBER

EXPIRATION DATE

CHECK ENCLOSED

Will you be needing hotel accommodations in NYC?
no yes don't know


Please print and mail this form to:
DACTYL FOUNDATION
64 GRAND STREET
NY, NY 10013

Make checks payable to "Dactyl Foundation."

Or you may pay your registration fee using PayPal.