COLD SPRING HARBOR LABORATORY

MEETINGS & COURSES OFFICE
1 BUNGTOWN ROAD
COLD SPRING HARBOR, NY 11724
Phone: (516) 367-8346
Fax: (516) 367-8845
Email: meetings@cshl.edu

CREDIT CARD AUTHORIZATION FORM

MEETING TITLE*_______________________________________________

CSHL ID#______________________DATE___________________________

NAME_________________________________________________________

AMOUNT______________CREDIT CARD BILLING ZIP CODE_________

FORM OF PAYMENT

CREDIT CARD---------------- ---------------- ---------------- ----------------

CREDIT CARD EXPIRATION______________________________________

CHECK NO.____________________________________________________

*ALL BALANCES ARE REQUIRED TO BE PAID IN FULL 4 WEEKS
PRIOR TO ARRIVAL. A PAID RECEIPT WILL BE INCLUDED IN
YOUR REGISTRATION MATERIALS WHEN YOU ARRIVE.