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).