Registration Fee (Please check appropriate fee)
Member of: ___IPT ___NTA
___ $200 Government/University
___ $275 Corporate/Business
___ $50 surcharge for non-members of IPT or NTA
Name____________________________________________________________________
First Name Preferred for
Badge_________________________________________________
Title_____________________________________________________________________
Affiliation_________________________________________________________________
Business
Address__________________________________________________________
City, State,
ZIP_____________________________________________________________
Phone __________________FAX ___________________ E-mail
____________________
Method of Payment
___ Check payable to Institute for Professionals in Taxation
___ American Express
___ MasterCard
___ VISA
Acct.
Number______________________________________________________
Exp.
Date__________________________________________________________
Signature
_________________________________________________________
Please include Billing Address if different from
Registration Address
ALL REGISTRATIONS MUST BE ACCOMPANIED BY FULL PAYMENT.
SEND PAYMENT TO:
Institute for Professionals in Taxation
3350 Peachtree Road NE Suite 280
Atlanta GA 30326
For information, contact IPT
Phone: 404-240-2300
FAX: 404-240-2315