2011 Public Health Emergency Preparedness in New York City - PHANYC - Public Health Association of New York City

Public Health Association of New York City
Legislative Breakfast 2012

*All fields are required.

Contact Information
Name:	*
Degrees:
Title:
Employer/School:
Address:
City:
State:
Zip:
Work Phone:	*
Home Phone:	(optional)
Fax:
Email:	*

Ticket Options

Breakfast Tickets
Regular ticket, PHANYC member $30
Regular ticket, non-member $35
Regular Membership ($70 value) plus member ticket ($30) $90

Regular ticket, new professional PHANYC member $25
Regular ticket, new professional non-member $30
New prof. membership ($50 value), plus member ticket ($25) $65

Regular ticket, PHANYC student/retiree member $20
Student/retiree ticket, non-member $25
Student/retiree membership ($30), plus student/retiree member ticket ($20) $40

Breakfast sponsorships
Bronze - 1 ticket, listing in program $150
Silver - 2 tickets, listing in program, reserved seating $300
Gold - 4 tickets, logo in program, reserved seating $500
Platinum - Reserved table for 8, logo in program, special recognition at event $1000

Donation:

Payment Information

Payment Method:

Check Credit

PHANYC accepts credit card payments through PayPal.

For credit card payment, you will be asked to enter your credit card information using our secure online bill pay form through PayPal.

*denotes required field

1710 First Avenue, Suite 282, New York, NY 10128
Copyright 2005 PHANYC | Design by Practis