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: _______________________________