Robert Zicklin Center for Corporate Integrity Corporate Governance Evening Seminar Series Improving Governance and Long-term Corporate Performance in an Age of Transparency Credit Card Payment Form Please complete this form and return via fax to 646-312-3232 or via mail to: The Robert Zicklin Center for Corporate Integrity Baruch College 1 Bernard Baruch Way, B 11-275 New York, NY 10010 Reigstration Fees: $250 for the complete Governance Series (4 sessions) $75 for each individual session Card Type _________________________ Expiration______________________ Date___________________ Amount___________________________________ Card Number_____________________________________________________ Authorized Signature_______________________________________________ Company_________________________________________________________ Contact Phone Number_____________________________________________ Name(s) of Registrant(s)_____________________________________________ ________________________________________________________________ ________________________________________________________________ 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, please. Determination of financial hardship is made on a case-by-case basis. All requests are confidential.