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.