Accounting Seminar Registration FormBreiseth Hall • 570-408-4235 (T) • 570-408-7846 (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 570-408-7846.
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 ____$45 _____$50 _____ $135 Nov. 5 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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