2010 Regulatory Compliance Update
2010 Regulatory Compliance Update Birmingham Marriott April 15, 2010
PLEASE COMPLETE A SEPARATE FORM FOR EACH ATTENDEE Credit Union:________________________________________________________ Mailing Address:____________________________________________________ Contact Phone Number:______________________________________________ Registrant Name: ____________________________________________________ Title:_______________________________________________________________ Email Address:_______________________________________________________ Payment Information 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)