E-mail: Firm/Company: Address: Program Fee (You may register online ... All cancellations must be received in writing vi
REGISTRATION FORM November One-Day Patent CLE Seminar The Princeton Club *Postponed to January 17, 2013
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Return this form with full payment to: NYIPLA Executive Office 2125 Center Avenue, Suite 406 Fort Lee, NJ 07024-5874
Phone: 1.201.461.6603 Fax: 1.201.461.6635 E-mail:
[email protected]
COMPLETED BY Contact Name
Phone:
(if contact is attending, must be listed below also)
E-mail: Firm/Company: Address: Program Fee (You may register online www.nyipla.org.) □ NYIPLA Member $440.00*
□ Non-NYIPLA Member $490.00
*I believe I am a member in good standing of the NYIPLA. If the records do not reflect membership in good standing, I authorize the NYIPLA to charge my credit card the non-member rate. Member rate will be applied to non-members joining within 30 days. Please register the following for the November One-Day Patent CLE Seminar to be held at the Princeton Club, 15 West 43rd Street, New York, NY. Paid registration includes lunch and program material.
NAME
Vegetarian
Mem/NM
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E-mail (Required)
Method of Payment Registrations will be processed only with full payment. □ Check - payable to NYIPLA in the amount of $________________ □ Credit Card - charge the amount of $________________ to
□ Visa
□ MasterCard
□ American Express
Name as it appears on the credit card
Signature
Date
Card Number
Expiration Date
CVV#
Cancellation Policy All cancellations must be received in writing via email at
[email protected] on or before Monday, October 15, 2012 – 12noon EST. No refunds will be issued for subsequent program cancellations or for no-shows. Full and partial scholarships are available for NYIPLA CLE programs to judges, judicial law clerks, full-time law professors, law students, attorneys employed by government agencies, unemployed attorneys and attorneys with demonstrated financial hardship. Requests for scholarships are considered on a case-by-case basis, and availability is subject to space limitations. To apply for a scholarship, submit a completed registration form together with a written request for financial relief that explains your current employment status and any financial hardship to:
[email protected] or the NYIPLA Committee on Continuing Legal Education, NYIPLA Executive Office, 2125 Center Ave., Suite 406, Fort Lee, NJ 07024-5874. Students must include a photocopy of their validated student identification card.
