First Name:     MI:   Last Name:

E-mail:          

Title:               

Bank/Firm: 

Address:      

City:                State:

Zip Code:      

Telephone:   Fax:

Immediate Supervisor:      
(Name and title)

Telephone:  

In case of emergency, contact:

Telephone:  

Fee Schedule
$1,725 per registrant for NYBA members (Members of other state bankers associations may register at the member rate)
$1,895 per registrant for non-members

The fee covers the cost of single room, meals, tuition and instructional materials. 

Payment Information
Mail check (payable to New York Bankers Association)
Please invoice me (for member banks/firms only)
Credit card - please call 212-297-1666 with number, or fax form to 212-297-1683 with credit card information
       (Only MC, Visa or Discover accepted) - provide card type, number, exp date and 3-digit security code

Billing Address for Credit Card Payment

First Name:    Last Name:

Bank/Firm: 

Address:      PO Box allowed

City:             State: Zip Code:  

Country:   

Cancellation Policy
Registrations cancelled prior to May 18, 2010 will be refunded in full.  Registrations cancelled on or after May 18, 2010, are subject to a $300 charge.  Registrations cancelled on or after May 27, 2010, are subject to a $600 charge.  registrations cancelled on or after June 1, 2010 are not refundable.  There is no charge for substitutions.  Requests for refund must be made in writing to the NYBA office.

Applicant Background Information

Educational Background (check highest level attained)
High School
Some College
Associate Degree
Bachelor's Degree
Master's/MBA Degree 
Law Degree
Other Advanced Degree

Total Years Trust/Estate Experience
Less than 2 years
2-4 years
5-7 years
8-10 years
11-15 years
16-19 years
20 years and above

Approximately how much of your time do you spend in the following areas?
New Business     %
Administration  %
Investments      %
Tax                       %
Other                   %

Please print this page for your records before submitting.