Low Income Taxpayer Clinic (LITC) Conference Registration
LITC name Address City Attendee Name Title Phone number E-mail address Fax number Emergency Contact Name & Telephone Number State Zip Code
Additional Attendee Information
Attendee name Title Phone number E-mail address Fax number Emergency Contact Name & Telephone Number
Additional Attendee Information
Attendee name Title Phone number E-mail address Fax number Emergency Contact Name & Telephone Number
Please note any accommodations you may need due to a disability:
Email completed form to Gerard.E.Pieger@irs.gov
Form
13321 (Rev. 11-2006)
Catalog Number 34831J
publish.no.irs.gov
Department of the Treasury - Internal Revenue Service