Identity Theft Prevention Workshop
Registration Form
Instructions:
1) Please print this page using the print function on your web browser
2) Complete one form for each attendee
3) Attach a check for $249 (ABA member); $299 (non-member)
4) Make check payable to American Privacy Consultants, Inc.
4) Mail completed form and check to:
American Privacy Consultants, Inc.
PO Box 2417, Alexandria VA 22301-0417
Name:
_______________________________________________________________
Title:
________________________________________________________________
Institution:
____________________________________________________________
Address:
______________________________________________________________
City:
__________________________State:
_________________Zip: ____________
Phone:
________________________Fax:
___________________________________
Email:
_________________________________________________________________
Location and Date of Workshop I will attend:
__________________________________
Additional
Resources and Products:
Please
send _____ copies of Privacy and Customer Information Security
– An Employee Awareness Guide
[Please
enclose a check for $99.00 ($125/non-ABA member) per copy + $5.95 for postage & handling]
____ Please contact me about multiple copy discounts
for the Employee Awareness Guide.
____ Please keep me informed
about other Identity Theft Prevention Workshops and materials.
____ Please contact me about a customized Identity Theft Prevention Program for my bank.