Registration

 
 
Course:  
Name:  
Title:  
Organization:  
Address:  
Telephone:  
Cell Number:  
Fax Number:  
E-Mail:  
Supervisor's E-Mail:  
Dietery Concerns:  
Other:  



(please note that your registration is sent after accepting the pop-up box after clicking submit)

*If you do not recieve a letter within 3 days of submiting this form please contact Nadina Chavez at 1-800-221-5994 at ext. 240 or by e-mail at nchavez@nysid.org
 
 
 
 
www.nysid.org