2017 Annual Meeting Registration First Name Last Name Phone Number Email Address Street Address City State Zip Code Number of seats to reserve at $15 each 1 person - $15 2 people - $30 3 people - $45 4 people - $60 5 people - $75 6 people - $90 7 people - $105 8 people - $120 9 people - $135 10 people - $150 Attendee Names Please specify any special dietary needs or allergies I am unable to attend, but would like to donate to support the programs and services of Upstate Cerebral Palsy Donation Amount Payment Pay Amount Card Number Expiration Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 CVC Prev Next