Jersey City Registration Form

Please fax completed form to 215-575-0401 or mail your completed registration form to
Ed Slott & Company, LLC, 1518 Walnut Street, Suite 1702, Philadelphia, PA 19102
Online registration availible at www.irahelp.com

Continuing Education

Insurance Credits by State

PACE:

CFP - 14 CREDITS
PACE - 14 CREDITS
CPE (for CPAs) - 14 CREDITS
CLE packets will be available for
attorneys
ERPA - 14 CREDITS

14 CREDITS: AL, AK, AZ,
CA, CO, CT, DE, DC, FL, GA,
ID, IL, IN, IA, KY, LA, ME, MD,
MI, MN, MO, NE, NV, NH,
NJ, NM, NY, OH, OK, OR,
SC, TX, VT, VA, WA, WI, WY

12 CREDITS: AR,
HI, KS, MA, MS, ND,
PA, SD, TN, UT, WV
6 CREDITS: NC
3 CREDITS: MT

LUTC Fellow	FSS
CFP	ChFC®
CLU®	CASL™
RHU®	REBC®
CLF®	CAP
MSFS	MSM

IMPORTANT: In order to receive CE credits, you must be present from 8:30 am to 5:30 pm on both days

	Single Payment of $1995
	Pay $665/month for 3 months if you register by February 1
	Pay $998/month for 2 months if you register by March 1

ATTENDEE INFORMATION

First Attendee Registration Fee................. $1995

First Name* Last Name*

First Name for Badge*

Company

Job Title

Address 1*

Address 2

City* State* Zip Code*

Phone* Fax

Email* Optional Registration Code

How Did You Learn About This Workshop?

PAYMENT INFORMATION

Please charge the registration fee to my:
Visa MC Discover Amex Gift Card

Card Number # Exp. Date

Name on Card CCV #

Number of Attendees:	Price per Attendee:
1	$1995
2-4	$1895
5-9	$1795
10+	$1695