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    Registration Information  Seating Plaque

   

All required fields are marked with a *

*
 Yes! I want to be a permanent part of Queens College history.
          Here is my contribution and a order for a Seating Plaque.

*  (Please check one of the radio buttons)
This is for Goldstein Theatre.
This is for Colden Auditorium.

* First Name:    
M.I.:    
* Last Name:    
    
* Street Address:    
Apt:
* City:    
* State:    
* Zip:    
* Home Telephone:    
Business Telephone:
* Email Address:    

*(Please check one of the radio buttons)
     This is a surprise gift. DO NOT send acknowledgement letter.
      Please send notification of this gift to:

First Name:    
M.I.:    
Last Name:    
    
Street Address:    
Apt:
City:    
State:    
Zip:    

* Please type the information exactly as you would like it to appear.
Maximun 20 characters per line, including spaces.

  Sample
IN MEMORY OF (IN HONOR OF)
JOHN DOE
 

For additional seating plaques, please type the information below.

This Seating plaque is a gift:
*(Please check one of the radio buttons)
 Alumni         Parent         Faculty/Staff         Friend

If you would like your seating plaque placed next to a friend's, your order must be placed together.


Please check the information above and verify that all is correct. Once you have done so, please click the Continue button below to enter your order., or click clear form to clear the form's contents.