Robert Zicklin Center for Corporate Integrity Presents:
Tenth Annual Financial Reporting Conference
May 5, 2011
Credit Card Payment Form
Please complete this form and fax to 646-312-3351
Registration Fees:
 Early Bird (by March 31) - $395
 Single Registration - $435
 Ten Person Group Registration - $3,500
 Non-Profit and Academic - $120
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.