Name:

Name of organization:

Address:

City: State: Zip:

Phone (day):

Email:

Registration fees include program, continental breakfast and lunch.

Please check one (call 716-829-3712 if special accommodations are needed):

$30 - Full time student only

$50 - Current 2007 NIA member*

$65 - Non-member

$80 - 2008 Individual Membership and Conference Fee**

Check for vegetarian lunch

* Indicates a 2007 paid membership.

** Individual Network membership is $30/year. If you are not a current Network member, you can register for the conference and receive the member discount rate by joining the Network now! Just click here for the 2008 membership form.

Send checks payable to:

Network in Aging of WNY, Inc., University at Buffalo - Kimball Tower, 3435 Main Street, Buffalo, NY 14214-3079