Accounting Seminar Registration Form

Breiseth Hall • (570) 408-5615 (T) • (570) 408-7912 (F) • Email

To register online for the accounting seminars, please click HERE.

Otherwise, please print and complete this form.

It should be mailed to the Center for Continued Learning at Wilkes University, 84 West South Street, Wilkes-Barre, PA 18766, or FAXed to the Center at 570-408-7912.

First Name __________________________   Last Name _______________________

Address ____________________________________

City ______________________________   State ____   Zip Code __________

Company Name __________________________________________________

Address ____________________________________

City ______________________________   State ____   Zip Code __________

Work Phone _________________   Home Phone ________________

Fax _________________   E-mail _________________

Social Security # ______________________________

Payment Information

Payment Amount ____$50 _____$55 _____ $145 Nov. 7, 2013 State Tax Update

___ Check   ___  Visa   ___ MasterCard   ____ Discover

Credit Card Number _______________________________   Expiration Date ________

3 digit verification code _________________________

Signature _______________________________________

Course Information

Seminar Name ______________________________________ Date ___________

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84 West South Street, Wilkes-Barre, PA 18766 |
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