Print this
form and send along with your check made payable to the Chicago Area IPT.
To: Chicago
Area IPT Abbott Laboratories, Dept 0367, Bldg AP6D-1, 100 Abbott Park Road,
Abbott Park, IL 60064
Chicago
Area IPT Luncheon
Registration for meeting to be held
__________________________
Name:
__________________________________________________________________
Company/Firm:
___________________________________________________________
Are you a
member of the National IPT (circle one): Yes No
Your area of
interest (circle all that apply): Property
Sales State Income
Your email
address: ________________________________________________________
If you are a
first time attendee please fill out the information below:
Title: ____________________________________________________________________
Address:
_________________________________________________________________
City:
____________________________________ State _____ Zip ________________
Phone:
(______) ________ ___________ Fax: (______) ________ ___________
Name to use
on name badge other than first name: _______________________________