Student Registration Information
Public Seminars

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 Seminar Registration
ACCTA, Inc.
P. O. Box 25602
St. Paul, MN 55125

Seminar Title: _________________________________________________

Date/Location: ________________________________________________

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.

Comments:
(Do you have particular needs or topics of special interest?)

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Rev. 07/08