Office Use: #_____________

 

CONFERENCE 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       

 

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 10065

Or email the form to:                                        clta.gny@gmail.com

You also can pay conference registration fee online: