Registration Form

Please complete this form to register for: ESRP Penalty Assessments (In-Person and Webinar)
Please make note of the meeting time and location: Maggiano's Little Italy (Northpark Center) 205 N Park Ctr.
Dallas, Texas, 75225 11:30 AM - 1:00 PM
NEW! The chapter will also be providing the program via webinar for those who cannot attend in person. Please select the webinar option when registering.

This program qualifies for one (1) CEBS compliance credit. Visit www.cebs.org/compliance for more information.

Please select one of the following options: *

$25 - Chapter Member $25 - DAHU Member $35 - Non-Member $10 - Webinar

Please indicate how you plan to attend the program? *

In-Person Via Webinar

Please select your payment options: *

PayPal (Once you hit submit you will be directed to the payment page to complete your registration payment) Pay at the Door (Please bring your check with you on the day of the program)

Do you have any dietary restrictions? *

Yes

Please list your dietary restrictions here: *

Registration Form - February 13, 2020