FITA - Fiscal and Infrastructure Technical Support Public Health Solutions (formerly MHRA)

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Common Cents Training Registration Form
Date: June 3rd & 4th, 2008
Time: 8:30AM to 5:00PM, both days

Location: Public Health Solutions
220 Church Street, 5th Floor
New York, NY 10013

Register by May 27, 2008 and receive a 10% discount on the registration fee.

Deadline to register is May 27, 2008. Due to space limitations, there is a limit of two (2) attendees per organization.



Cost and Billing Information:
The price for Common Cents© is on a sliding scale based on the size of your agency’s budget as reported on the most recently filed IRS Form 990.

Agency Budget Cost for 1 Attendee Cost for 2 Attendees

<$500,000 $550 $825

$500,000 - $1 million $600 $900

$1 - $2.5 million $650 $975

$2.5 - $5 million $700 $1,050

$5 - $7.5 million   $750 $1,125

$7.5 - $10 million   $800 $1,200

$10 - $12.5 million   $850 $1,275

>>$12.5 million $900 $1,350


Once your registration has been received, you will receive an invoice and payment instructions via e-mail within 2 business days. If you wish to pay by credit card over the phone, complete the on-line registration form, then call Andrew Owens and (646) 619-6511. If you have any questions about FITA’s Common Cents©, please contact Ghassan Khalil at (646) 619-6505 or gkhalil@fita-mhra.org.

Fields marked with * are Required.
Registrant 1
First Name *
Last Name *
Title *
Phone *
FAX
E-mail *

Registrant 2 (if applicable)
First Name
Last Name
Title
Phone
FAX
E-mail

Organization
Agency Name *
Street Address *
Address (cont.)
City *
State *
Zip * -
Budget Size (based on latest 990 filed): *

Verification:  
(Please Enter the characters you see)



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