Suffolk County Legislature Form Center

CHARTING THE COURSE: Suffolk County - We Mean Business!

2. When:
   Friday December 7, 2018 | Registration 7:30 AM - 8:15 AM | Program Begins 8:30 AM

   Friday December 7, 2018 | Registration 7:30 AM - 8:15 AM | Program Begins 8:30 AM

3. Where:
   Farmingdale College, Roosevelt Hall, Farmingdale, NY

   Farmingdale College, Roosevelt Hall, Farmingdale, NY

5. Contact:
   Fran Evans, Office of Presiding Officer DuWayne Gregory | 631-853-5499 | Fran.Evans@suffolkcountyny.gov

   Fran Evans, Office of Presiding Officer DuWayne Gregory | 631-853-5499 | Fran.Evans@suffolkcountyny.gov

7. Registration Information:

9. First Name:*

10. Last Name:*

12. Business Name:

13. Title:

15. Address 1:*

17. Address 2:

19. City:*

20. State:*

21. Zip Code:*

23. Email Address*

25. Phone Number:*

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27. 1. Receive an email copy of this form.
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