Office Use: #_____________

CONFERNECE REGISTRATION FORM

CHINESE TEACHERS ASSOCIATION OF GREATER NEW YORK

Family Name	English		Given Name		English
	中文				中文
Affiliation:		Work address
Email 1		Home address
Email 2
Fax
Telephone	Work			Home
Registration Fee: $20 □ If you are a CLTA-GNY member and wish to renew your membership at the conference, please include the appropriate membership fee. Please see the fee schedule at http://clta-gny.org/join-membership.htm. Make check payable to CLTA-GNY.						Membership Status Yes □ No □

Please send the form back to: Chinese Language Teachers Association of Greater New York
125 East 65th Street, New York, NY 10021

Web Site: http://clta-gny.org