Conference Registration: Arts Education – to what end?
March 7 and 8, 2008
Please note that you will not be registered for the conference until this form is received with full payment. Please complete and
return this registration from along with payment to the Office of Special Programs, 82 Washington Square East, 5th Floor, New
York, NY 10003-6680. Fax: 212-995-4923. Phone: 212-992-9380 Please make a copy of this form for your records.
1. NAME:
2. EMAIL:
(First)
(M.I)
(Last)
3. Names of any additional attendees included in payment:
4. TITLE:
______________
5. AFFFILIATION
6. PROFESSION:__________________________________________________________
7. MAILING ADDRESS:
(Street)
(Apt. #)
(City)
8. BILLING ADDRESS:
(if different than above)
(State)
(Zip Code)
(Street)
(Apt. #)
(City)
(State)
9. DAYTIME PHONE: ______________10. NIGHTTIME PHONE:
(Zip Code)
11. CELL PHONE:
Presenter and attendee rate: $150.00
Current NYU student rate: $50.00
11. CONFERENCE PAYMENT ENCLOSED:
Credit Card Payment  Visa
(you may pay with credit card or a personal check made out to New York University)
 MasterCard
 American Express
Total Amount Authorized: $ ___________________________________________
Credit Card Number: ___________________________________________
Expiration Date: Month ________ Year________
Cardholder’s Signature:
Date ____________________
Please complete and return this registration from along with payment to the Office of Special Programs, New York University,
82 Washington Square East, 5th Floor, New York, NY 10003-6680. Fax: 212-995-4923. Phone: 212-992-9380
Please make a copy of this form for your records.