Please provide the following information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
E-mail
Special Dietary Needs
Payment Method:	Check Google
Name of Cardholder (Google Checkout)

Winter Seminar Registration Fee (includes breakfast and breaks, but not lunch)

Refund Policy
No refunds for seminar fees after January 5, 2009, but an agency may send someone in place of a registrant who cannot attend.

If paying by check, mail payment to:

Association of Government Accountants
Nashville Chapter
P.O. Box 198025
Nashville, TN 37219

Questions? E-mail or call Rusty Lacy <Rusty.Lacy@tn.gov> (615) 401-7764 or Brian Brechon (Brian.Brechon@tn.gov) (615) 401-7746