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2012 Intermediate Real Property Tax School

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					                                      2012 Intermediate Real Property Tax School
             April 29-May 4, 2012 at Marriott Kingsgate Conference Center, University of Cincinnati, Cincinnati, Ohio
                                                  REGISTRATION FORM                                                                          Tools of the
   Mr      Ms   Full Name:                                                        Badge Name:                                     CMI         Profession
                                                                                                                                           Faxed registrations will be
Title:                                                       Company:                                                                      accepted but are subject to
                                                                                                                                           the same $100 cancellation
Address:                                                                                                                                   and surcharges as
City:                                                             State:                           Zip :                                   registrations accompanied by
                                                                                                                                           full payment. Refunds,
Phone:                                                            Fax:                                                                     subject to a cancellation
                                                                                                                                           charge of $100, will be made
E-mail:                                                   Arrival Date:                         Arrival Time:                              upon written notification of
                                                                                                                                           cancellation received by April
                                                                                                                                           20, 2012. No refunds will be
Profile Information (to be used for developing a profile and is confidential)                        Age:
                                                                                                                                           made after April 20, 2012.
Industry Description (e.g., manufacturingconsulting, etc.):
                                                                                                                                           There is also a substitution
Education           No College                              Associate                Baccalaureate              Advanced
                                     Some College                                                                                          charge of $40 before March
Major:                                                                                                                                     29, 2012; $50 after that date
                                                                                                                                           (plus cost of delivery of any
Texas property tax consultant license number:                                                                                              materials, etc.).
State Bar/ Attorney/ CPA number & state licensed:
                                                                                                                                           Enrollment is limited to
Other organizations certified or licensed:                                                                                                 member companies and
                                                                                                                                           employees of government
Title of position you currently hold (Select one title that most closely reflects your actual title)                                       agencies.
          Property Tax Specialist                   Accounting Manager/Supervisor              Tax Accountant/Staff Accountant             Make checks payable to:
          Representative/Agent/Analyst              Tax Consultant                             Assistant Tax manager                       Institute for Professionals in
                                                                                                                                           Taxation and mail to:
          Tax Administrator                         Assistant Manager, Property Tax            Controller/Comptroller
          Assistant Supervisor, State/Local         Manager, Property Tax                      Accounting Clerk/Tax Clerk                  1200 Abernathy Road
          Tax Attorney for Corporation             Assistant Director - Taxes                  Appraiser                                   Bldg. 600, Suite L-2
                                                                                                                                           Atlanta, Georgia 30328
          Attorney                                  Tax Supervisor State/Local                 Tax Manager
                                                                                                                                           Phone: 404/240-2300
                                                                                                                                           Fax: 404/240-2315
 No. of Years Work Experience: Real Property Tax                  Property Tax                             Total Full-Time Work

 List other IPT schools that you have attended:

REGISTRATION FEES                                                                 By March 29, 2012 After March 29, 2012
Member registration fee (I personally hold a membership)                              $775                       $800
Non-Member registration fee (individual does not hold
membership, but company/firm has members in IPT)                                      $975                        $1,000

Non-Member Company registration fee (no members)                                      $1,075                     $1,100
Supplemental Fee for not residing at conference center
(not staying at the hotel under the IPT Group rate)                                   $500                       $500
"Property Taxation" book published by IPT (nonrefundable)                             $75                        $75
Become "Property Tax Associate Member" *                                              $275                       $275
                                                                                                                                                          TOTAL FEES
* My company has a membership in IPT, so I am enclosing my associate membership application with the
nonrefundable $275 dues to make me eligible for "member tuition fee" of $775 (by March 29) or $800 (after March 29).

METHOD OF PAYMENT
    Check                                                                       Credit Card:                     Master Card        Visa                    AMEX
Please make check payable to:                                     Card Number:
Name: Institute for Professionals in Taxation
Address: 1200 Abernathy Road, NE                                  Expiration Date (MM/YY):
         Building 600, Suite L-2                                  Card Holder Name:
         Atlanta, GA 30328
Phone: (404)240-2300                                              Signature:
Fax:     (404)240-2315                                            Billing Address:


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posted:2/14/2012
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