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Connecticut CPA
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March/April 2014
Registration Form
The Essential Event:
The 2014 CTCPA Annual Meeting
Ready to sign up? Use this form to:
Purchase one to three seat(s) or Purchase four to seven seat(s) or
Purchase eight or more seats and become an event sponsor you'll get: a discounted group rate, your firm
listed on the CTCPA website and in follow-up coverage in Connecticut CPA magazine, and recognition in the event's
opening slideshow loop and printed program.
Firm Information
(Event sponsors: Indicate below how you would like your firm to appear in all marketing.)
Firm Name ______________________________________________________________ City/Town __________________________
Firm Contact
Name ____________________________________________
Phone ___________________________________________ Email ____________________________________________________
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
Payment Information
(Payment is required to reserve seats.)
Purchase one to three seat(s):
Number of seats _______ @ $170 per seat ($160 before April 30, 2014). Total enclosed: $_______
Purchase four to seven seats:
Number of seats _______ @ $150 per seat ($140 before April 30, 2014). Total enclosed: $_______
Purchase eight or more seats:
Number of seats _______ @ $140 per seat ($130 before April 30, 2014). Total enclosed: $_______
Card# _____________________________________________________________ Exp. Date ______________________________
Cardholder's Name __________________________________ Cardholder's Signature __________________________________
Billing Address Street _______________________________________________ City, State, Zip __________________________
Make checks payable to CTCPA or pay with a Visa, MasterCard, or American Express credit card.
Fax registrations with credit card to 860-571-6830 or register online at www.ctcpas.org/EssentialEvent.
Mail registrations with checks to Essential Event, 716 Brook St., Suite 100, Rocky Hill, CT 06067.
Questions? Contact CTCPA Membership Associate Liz Frazza at lizf@ctcpas.org or 860-258-0220.
To reserve additional seats, copy and return this form.
Please r
eturn this for
m
with payment by Mar
ch 1, 2011.
Register bef
ore
April 30, 20
14 and sa
ve!
Monday, May 12, 2014
Aqua Turf Club, Plantsville