background image
9
advocacy community education
9
Attendees
(Please list all registrants. Not sure who's attending? We'll call you later on for names and meal choices.)
1. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
2. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
3. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
4. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
5. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
6. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
7. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
8. ______________________________________________ Meal: p chicken florentine p NY strip sirloin p salmon
Fax registrations with credit card to 860-258-4859 or register online at www.cscpa.org/EssentialEvent.
Mail registrations with checks to Essential Event, 716 Brook Street, Suite 100, Rocky Hill, CT 06067.
Questions? Contact CSCPA Membership Associate Liz Frazza at lizf@cscpa.org or 860-258-0220.
To reserve additional seats, copy and return this form.
Firm Information
(Event sponsors: Indicate below how you would like your firm to appear in all marketing.)
Firm Name _______________________________________________________ City/Town ____________________
Payment Information
(Payment is required to reserve seats.)
Purchase one to five seat(s):
Number of seats _______ @ $150 per seat. Total enclosed: $_______
Purchase six or more seats:
Number of seats _______ @ $125 per seat. Total enclosed: $_______
Card# _______________________________________________________ Exp. Date ________________________
Cardholder's Name____________________________ Cardholder's Signature ______________________________
Billing Address Street __________________________________________ City, State, Zip _____________________
Make checks payable to CSCPA or pay with a Visa, MasterCard, or American Express credit card.
The Essential Event:
The 2011 CSCPA Annual Meeting
Registration Form
Firm Contact
Name ____________________________________________
Phone __________________________________________ Email _______________________________________
Ready to sign up? Use this form to:
Purchase one to five seat(s) or
Purchase six or more seats and become an event sponsor you'll get: a discounted group rate, recognition
on the CSCPA website and in follow-up coverage in Connecticut CPA magazine, recognition in the event's agen-
da and opening slideshow loop.
Consider
bringing
several
clients!