Robert Zicklin Center for Corporate Integrity Presents: Putting $$$ on Green November 7, 2008 Credit Card Payment Form Please complete this form and fax to 646-312-3351 Registration Fees: General registration - $150 Discounted fee for members of co-sponsoring organizations, academics, and alumni - $75 Card Type _________________ Expiration Date______________Amount____________ Card Number_____________________________________________________________ Authorized Signature______________________________________________________ Contact Phone Number_____________________________________________________ Company________________________________________________________________ Print 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.