CONVENTION REGISTRATION FORM

Registrations must be received by September 3, 2004. We got an extension!

Please use ink and print neatly.

Name(s): Address(s): Phone(s):

( )

( )

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$ D – Convention ticket, includes luncheon ($35 each)

$ G – Convention ticket, includes luncheon – Student Rate ($25 each)

Make checks payable to NYSRTLC. Return this form with your payment to:

NYSRTLC 41 State Street Albany, NY 12207

ADVERTISING SUPPORT & SPONSORSHIP

$175 Full Page Ad (10” x 7.5”)

$100 Half Page Ad (4.75” x 7.5”)

$75 Quarter Page Ad (4.75” x 3.5”)

(For above, please provide camera–ready ads if at all possible.)

$45 Business Card Ad (2” x 3.5”)

$25 Special Church Listing

$ A – Amount Enclosed Size of Advertisement

$1000 Platinum Sponsor

$500 Gold Sponsor

$250 Silver Sponsor

$100 Bronze Sponsor

Sponsors will be recognized in the billing of the event.

$ B – Amount Enclosed

Make checks payable to NYSRTLC. Return this form with your payment to:

NYSRTLC 41 State Street Albany, NY 12207