CPA Conference Registration Form Print

(Click the Print Icon at the Right to Print) 

 
How to Register:  Complete form and email, fax or mail to:
    Coalition for a Prosperous America (c/o Michael Stumo)
    615 Boardman St.
    Sheffield, MA 01257
    Tel: 413.854.2580
    Fax: 413.854.2579
    Email: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

For Registration Questions, please contact Michael Stumo  (see above)

Hotel registration:     Gateway Hotel and Conference Center
                                     2100 Green Hills Dr., Ames, IA 50014
                                     Call: 515-292-8600 – ask for the CPA room block ($99/night)

         (Hotel booking deadline is May 29, 2007!)



Name:            __________________________________________________


Organization:    __________________________________________________


Address:          __________________________________________________


City/State/Zip:    _________________________________________________


tel:                __________________________________________________


email:            __________________________________________________


___    Number attending the Conference  @ $50    $__________

TOTAL DUE NOW:                                          $__________

Meals:  $40 for dinners, $25 for lunches, payable at the conference.

Please make checks payable to CPA.
 
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