ARCPA.org - Multiple Registration

Multiple Registration - Multiple Courses

Registrant Information

Registrant 1:

First Name:
Last Name:
Certificate #
AICPA Member:
Are you a member of your State Society?
If yes, what State?

Registrant 2:

First Name:
Last Name:
Certificate #
AICPA Member:
Are you a member of your State Society?
If yes, what State?

Registrant 3:

First Name:
Last Name:
Certificate #
AICPA Member:
Are you a member of your State Society?
If yes, what State?

Company:
Street Address:
City:
State:
Zip Code:
Telephone:
Fax:
Email:
Website:

Course Information

Course Title:
Date(s):
Location:
Registration Fees:
Registrant 1:	$
Registrant 2:	$
Registrant 3:	$
Subtotal:	$
AICPA Discount: (Only if applicable AICPA Members receive a $30 per course discount only on AICPA sponsored courses.)	$
Total Registration Fees:	$
Payment Method:
Credit Card #:
Expiration Date:
Cardholder Name:

How to Register:

1) Print and fax this form, with MasterCard, Visa, or American Express information, to 501-664-8320.

2) Or, you may mail this form, with a check, to Arkansas Society of CPAs, 11300 Executive Center Drive, Little Rock, AR 72211-4352.

3) Or, you may register by phone, with your MasterCard, Visa or American Express, by calling 501-664-8739 or 800-482-8739 (in Arkansas).

4) Or, you may submit this form via e-mail, by pressing the "submit" button below.

Please Note: Payment is required in order to reserve your registration in a class. Submitting this form without payment does not guarantee your registration. Mailed payments should be received 10 days prior to the course date, or the registration will be cancelled.

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