Name: ____________________________________Delegate? Yes___     No___
 
Name: ____________________________________Delegate? Yes___     No___
(Please print your name as you would like it to appear on your name tag)

Address: ___________________________________________________________
___________________________________________________________
 
Room and Meals: Contact the Athenaeum Hotel directly at 716-357-6239 or e-mail athenaeum@netsync.net, attention Bruce Stanton.   Please mention the Federation of New York State Bird Clubs.

Registration
(All attendees must register)

	Qty.	Per Person	Total
Registration Fee - Postmarked on or before August 1		$25.00
Registration Fee - Postmarked after August 1		$30.00
Registration Fee - Student		$10.00
Total Registration Fees

Please make checks payable to: Lake Erie Bird Club	Mail to:	Dick Miga 38 Elm St. Fredonia, NY 14063
Questions?  Contact Dick Miga via email or by phone at 716-672-7363