Mid Atlantic Plan Sponsors - Registration Form

Contact Information

Fund Trustees, Administrator or Guest Information

Please Select Appropriate Registration

No longer available

Payment

Whats This?

For Visa, MasterCard and Discover the secure code is the 3 digit value printed on the signature panel located on the back of your card. It is the last 3 numbers in that area.

Billing Address

(Please Type Name on Above Line)
Total Amount That Will Be Charged: $

Make Check Payable To: MID ATLANTIC PLAN SPONSORS

Mail Check To:

ATTN: Aileen Rappaport
Mid-Atlantic Plan Sponsors
11140 Rockville Pike - Suite 100 - 324
Rockville, MD 20852
USA
Total Amount Due: $

Comments

BY SUBMITTING THIS FORM, I CERTIFY I HAVE READ AND UNDERSTAND THE TERMS OF THIS REGISTRATION.

IF PAYING BY CREDIT CARD, I AUTHORIZE MID ATLANTIC PLAN SPONSORS TO CHARGE MY CARD FOR THE TOTAL AMOUNT INDICATED.

THERE WILL BE A $35.00 FEE CHARGED ON CHECKS RETURNED BY THE BANK DUE TO INSUFFICIENT FUNDS.