Part I: Seminar Registration

Asterisk (*) indicates required data input

Name of Individual
sending this form *

Company *


Phone *


eMail *

 

Register the following HCBFFA Members

(Enter the name of each member you wish to register for this
luncheon in the field below; use a comma to separate names)

Register the following Guests

(Enter the name of each guest you wish to register for this
luncheon in the field below; use a comma to separate names)

If CEU Credit does not apply or if you are not
requesting CEU credit for this luncheon seminar
and have completed the luncheon registration
portion above, click here to go directly to the
bottom of the page and click the "Submit" button.

 

Part II: CEU Registration

COMPLETE THIS PORTION OF THE FORM ONLY
IF CEU CREDIT APPLIES TO THIS LUNCHEON.

If CEU credit applies to this luncheon and you are requesting
CEU credit for attending this seminar, complete this portion of
the form.  Below, you may register as many as six people for
CEU credit for attending this luncheon seminar.

Please complete this portion of the form carefully.

Incomplete information or errors due to user input will
disqualify the CSS Registrant from receiving CEU credit.

 

CCS Registrant #1

The following individual is requesting CEU credit
for attending this luncheon seminar:

Yes              No
                    

CSS Member ID

First Name

MI/Name

Last Name

Company

Address

City

State

Zip

Phone

Fax

eMail

If you are finished completing the form at this point, click here to
go directly to the bottom of the page and click the "Submit" button.

 

CCS Registrant #2

The following individual is requesting CEU credit
for attending this luncheon seminar:

Yes              No
                    

CSS Member ID

First Name

MI/Name

Last Name

Company

Address

City

State

Zip

Phone

Fax

eMail

If you are finished completing the form at this point, click here to
go directly to the bottom of the page and click the "Submit" button.

 

CCS Registrant #3

The following individual is requesting CEU credit
for attending this luncheon seminar:

Yes              No
                    

CSS Member ID

First Name

MI/Name

Last Name

Company

Address

City

State

Zip

Phone

Fax

eMail

If you are finished completing the form at this point, click here to
go directly to the bottom of the page and click the "Submit" button.

 

CCS Registrant #4

The following individual is requesting CEU credit
for attending this luncheon seminar:

Yes              No
                    

CSS Member ID

First Name

MI/Name

Last Name

Company

Address

City

State

Zip

Phone

Fax

eMail

If you are finished completing the form at this point, click here to
go directly to the bottom of the page and click the "Submit" button.

 

CCS Registrant #5

The following individual is requesting CEU credit
for attending this luncheon seminar:

Yes              No
                    

CSS Member ID

First Name

MI/Name

Last Name

Company

Address

City

State

Zip

Phone

Fax

eMail

If you are finished completing the form at this point, click here to
go directly to the bottom of the page and click the "Submit" button.

 

CCS Registrant #6

The following individual is requesting CEU credit
for attending this luncheon seminar:

Yes              No
                    

CSS Member ID

First Name

MI/Name

Last Name

Company

Address

City

State

Zip

Phone

Fax

eMail

 

 

For questions or information, please contact:

Jeannie Angeli
HCBFFA Administrative Manager

Phone: 713 678-4300

Read Carefully, Then Click "Submit" Button:

Once you have entered the required registration information above for all
players you are wishing to register, click the SUBMIT button (once, please).

After clicking the Submit button (only once, please), a confirmation page
will appear on your screen to confirm that your information has been posted.
The confirmation page contains instructions for making your payment.

Please be patient, as it may take more than 60 seconds for the confirmation
page to appear.  Do not back out of this page until the confirmation page
appears on your screen.  The confirmation page is your assurance that
your information has been posted in HCBFFA's registration system.