Fordham Centenarian Study Reception

Date: Sunday, November 11th, 2pm to 4 pm.

Location: Fordham University, 12th Floor Lounge, Lowenstein Building, 113 West 60th Street, New York City.

1. Please provide the following information about your party. In case you are attending the event because of a specific centenarian please indicate his or her name (if not, please leave the following fields empty):

2. Is this centenarian attending the Fordham Centenarian Study Reception?

3. Your name:

4. Number of guests (not including the centenarian):

5. Please provide contact information for the primary contact of your party (email address or phone number):

6. Please provide the names of any guests (not including the centenarian) that will be attending the reception (in case you want to bring more than 5 guests, please write their names in the comment field below):

7. Comment: Please let us know if you have any specific needs (e.g., accommodation or transportation).