Student Registration Information
Public Webinars

Thank you for registering for our public seminars. Please provide the following information.

Print the completed form and fax to 651-730-0965, or mail to:
Public Webinar Registration
ACCTA, Inc.
P. O. Box 25602
St. Paul, MN 55125

Seminar Title: _________________________________________________

Date/Time: ________________________________________________

Student Name: ________________________________________________

Organization: _________________________________________________

Address: _____________________________________________________

Phone: ___________________________

Email: ___________________________

Fax: _____________________________

Payment Information:

___ Check (included)

___ Purchase Order

P. O. Number _______________ (attach copy of P.O.)

Total $____________
  • If you are paying by Purchase Order or check, registration will not be accepted until we have received the P.O. or check.
  • Cancellation of a registration more than two weeks before the seminar will incur a $25 processing charge. If you are paying by P.O., you will be billed for the processing charge.
  • No refunds will be given for cancellations within two weeks of the seminar. If you are paying by P.O., you will be billed for the entire registration cost.
Number Ordered
Registration Type
Cost
Notes
x
Single Registration
$99
Permits a single individual to listen to the presentation.
x
Single Registration + Presentation File
$159
Single registration and receive the presentation file for personal use.
x
Single Registration + Presentation File + Recording
$197
Single registration, with the presentation file and recording.
x
Office Registration
$297
Everyone from a single office or lab can listen to the presentation (multiple viewers at a single display).
 
Office Registration + Presentation File
$359
Office registration and receive the presentation file for local use.
 
Office Registration + Presentation File + Recording
$397
Office registration, with the presentation file and recording.

 

Comments:
(What do you hope to learn from this presentation? Are you having particular problems that you hope to solve?)

____________________________________________________________________________________________
Rev. 08/12