SCRLC Registration Form

South Central Regional Library Council

WORKSHOP REGISTRATION FORM

When using this form, it is important to indicate which workshops/events/series you wish to attend.

To complete your registration, please email, fax or mail this form and payment to:

SCRLC, Clinton Hall, 108 N. Cayuga St., Ithaca NY 14850

Telephone: 607-273-9106 Fax: 607-272-0740

Email: dcapalongo@lakenet.org

Email confirmations will be sent promptly

Name ______________________________________________________________

Institution ____________________________________________________________

Address _____________________________________________________________

Telephone (day) _____________________________Emergency* ________________

*Emergency phone will only be used for a last minute change or cancellation.

Email Address ________________________________________________________

Workshop ________________________ Date _____________ Fee __________

All registration and payments are due two weeks before the event.

We accept MasterCard, Visa, Discover, and American Express or Checks

Name of Card Holder __________________________________________________

Signature ___________________________________________________________

Credit Card #____________________________________ Total Charge________

3 Digit "Verification Code" from back of card ____________ Expiration Date________

SCRLC Cancellation Policy:
Notification must be received 24 hrs before the workshop to avoid a $20.00 processing fee. Prepaid registrations cancelled within 24 hours of the workshop, will be issued a credit voucher less $20.00; all others will be invoiced. Refunds cannot be made for no shows.