2010 Collections & Bankruptcy School
2010 Bankruptcy School Orlando, Florida – October 13, 2010 Credit Union___________________________________________________________ Mailing Address:_______________________________________________________ Contact Name & Phone Number:__________________________________________ Registrant Name: __________________________________Title:_________________ Email Address:__________________________________________________________ Registrant Name: __________________________________Title:_________________ Email Address:__________________________________________________________ Payment Information: Bankruptcy School ONLY - $249/person CREDIT CARD AUTHORIZATION Credit Card Number
___ VISA
___ MasterCard Expiration Date
Cardholder’s Billing Address ____________________________________________________________ City/State/Zip
Print Name Authorized Signature CVV Number (three digit number found on back of card) Total = ___________
* Please return completed form to Becki Payne @ becki.payne@lscu.coop or fax # 205.991.2576