Hasselback Tax Seminar Registration Form

To Register: Please complete the following form, one form per participant. Fields marked with an asterisk (*) are required.

Company: ______________________________

First Name: (required)* ______________________________

Last Name: (required)* ______________________________

Street Address: (required)* ______________________________

Street Address 2: ______________________________

City: (required)* ______________________________

State: (required)* ______________________________

Zip: (required)* ______________________________

Email: (required)* ______________________________

Phone (day):(required)* ______________________________

Phone (eve): ______________________________

Phone (cell): ______________________________

IRS PTIN Number: ______________________________

Seminar Date(s) you are registering for: ______________________________

Email your registration: E-Mail

After submitting your registration form by Email, please submit your payment. To pay by check, please make the check payable to James R. Hasselback.

Print this form and mail with your payment to:

2910 Kerry Forest Pkwy #D4-357
Tallahassee, FL 32309
Phone/Fax/Recorder: 850-894-2244

Single Participant: Groups of 5 or more (complete 1 form for each participant):
Seminar: $180.00 $162.00

To pay using PayPal, first submit your registration by Email, and then proceed to the PayPal payment page.