Advanced Charitable Planning Workshop

Contact Information

Name: 

Name to appear on badge: 

Company: 

Professional Designations: 

Broker/Dealer: 

Address: 


City: 

State: 
AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code: 

Phone: 

Fax: 

E-Mail Address: 

How do you represent yourself to the public? (check one)   
Attorney
CPA
Company Marketing Rep
Financial Planner
Home Office Employee
Planned Giving Officer
Other:
Please check the date you will be attending the program 
May 18, 2012
How did you hear about the Renaissance Advanced Charitable Planning Workshop?   
Postcard
Brochure
Website
Referred by:  
Other:  

Payment Options:

The one-day program at $149 includes tuition, lunch and training materials 
Option 1: Sending a check for $149.
Option 2: Paying full amount by credit card. Please contact me.
Option 3: Sending a check for "Bring a Co-worker" fee of $99.
Option 4: Paying the "Bring a Co-worker" fee of $99 by credit card. Please contact me.