PERSONAL INFORMATION:
 Name as it should appear on name badge:

   First:    Last: 

   Affiliation: 

 Mailing Address:

   Line 1: 

   Line 2: 

   Line 3: 

   Line 4: 

   Line 5: 

   Day Phone:   Fax: 

   Email: 

TRAVEL INFORMATION:
 Mode of Travel:   Car      Train

                   Air (Arrival Airport:   JFK    LaGuardia    Islip)

 Arrival Date:   //1999   Time:    Airline/Flight #: 

 Departure Date:   //1999   Time:    Airline/Flight #: 



 Daily transportation from hotel to campus needed:  Yes    No

 Parking Permit Required:  Yes  No

FEES FOR PARTICIPANTS:
  Registration:               Cost if received on or          Cost if received
                              before April 29, 1999           after April 29, 1999

  (Please check one:)          $125                          $150

  Includes coffee breaks, two lunches, one dinner, a concert and the banquet.
  Transportation will be provided between the Holiday Inn and the campus.

  Please check your choice of banquet entree:

              filet mignon              poached salmon            pasta primavera



ADDITIONAL BANQUET TICKETS
  Single Ticket:               Cost if received on or         Cost if received
                               before April 29, 1999          after April 29, 1999
                                                              (Subject to availability)

  (Please check one:)           $50                           $60
  Number of Tickets:                                       

  Please give numbers for each banquet entree:

             filet mignon         poached salmon       pasta primavera 


TOTAL:

   Please sum all the above amounts:              Total:  $ 


Make checks or money orders payable to "Stony Brook Foundation Acct. # 284100."

Please note our cancellation policy: There is a full refund for
cancellations before April 8, 1999, a 50% refund for cancellations
between April 9, 1999 and April 29, 1999 and no refund for
cancellations after April 30, 1999.

After submitting this form, please mail payment to:

   Office of Conferences and Special Events
   440 Administration
   State University of New York at Stony Brook
   Stony Brook, NY, 11794-1603
   U.S.A.