The Robert Zicklin Center for Corporate Integrity Presents:
The 6th Annual Audit Conference
December 1, 2011
Credit Card Payment Form
Please complete this form and fax to 646-312-3351
Registration Fees:
$395 Single Registration
$3,000 for an eight person table (contact 646-312-3231 for more information)
$145 Academic and non-profit registration fee
Card Type _________________ Expiration Date______________Amount____________
Card Number_____________________________________________________________
Authorized Signature______________________________________________________
Contact Phone Number_____________________________________________________
Company________________________________________________________________
Print Name(s) of Registrant(s)_______________________________________________
________________________________________________________________________
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Please contact Matthew LePere at Matthew.LePere@baruch.cuny.edu or 646-312-3231
with any questions or information requests.
Special financial arrangements can be made for those who demonstrate financial hardship. Please contact
the Center for Corporate Integrity for information on guidelines and procedures. Determination of financial
hardship is made on a case-by-case basis. All requests are confidential.