Stock Trading Techniques Seminar Sign up Form

Please provide the following information then click the Send button below to submit your registration.
1.	Last Name:
	First Name:
2.	Address:
		City:   State:  Zip Code:
3.	Phone Number:	()   -
4.	E-mail Address:
5.	Class Date:   Please select the date       Other       (Please check the class schedule)
6.	Payment Option: Check: Please make your check payable to White Pacific Securities, Inc. and mail it to: Marketing Department White Pacific Securities, Inc. 100 Pine Street, Suite 500, San Francisco, CA 94111 Credit Card: Please call 415-276-2805 to provide your credit card information.
7.	Where did you hear about the seminar?   Sing Tao Daily, Sing Tao Chinese Radio, World Journal, World Journal Website, Channel 38, SVC Radio, Broker, Friends & Family, Other:
8.	Do you have an account with us?  Yes No If no, your brokerage firm:
9.	Notes: