MHANYS 2023 Annual Awards Dinner

October 23, 2023 at Crowne Plaza Albany - The Desmond Hotel

Annual Awards Dinner Registration Information

First Name *

Last Name *

Title

Organization Name

Street Address *

City *

State *

Zip Code *

Email *

Phone *

Dietary Restrictions

Special Requests

Event Fee(s) *

Affiliates - $ 100.00

Non-Affiliates - $ 125.00

Total

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province

Postal Code

Vegetarian	Vegan
Gluten Free	Kosher
Other (Please specify in special requests field below)