Contact us at 631-261-0242 or at info@visionlongisland.org for more information.

ONLINE REGISTRATION IS OPEN!

[ ] $2,000 Sponsor [ ] $1,000 Sponsor [ ] $500 Sponsor [ ] ___ seats ($45/person)
Method of Payment: [ ] Check enclosed [ ] Check sent (faxed only) [ ] Pay at the door [ ] Credit Card

Attendee Name(s): ____________________________________________________________________________________________

Affiliation:_____________________________________________________________________________________________________

Address: ____________________________________________________City, State, Zip: ___________________________________

Email: _______________________________________ Phone: ____________________________ Fax: ________________________

Credit Card: [ ] Visa [ ] MasterCard [ ] American Express Name, as it appears on card: ____________________________________

Credit Card Number: __________________________________________________ Expiration Date: ___________________________

RSVP or ask any questions by phone to 631-261-0242, by email to info@visionlongisland.org or by fax to 631-754-4452.

Participating Organizations include

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