Registration Form

Course Dates for Advanced Certificate in Employee Benefits Law Seminar:

___ 2009 date(s) to be announced

Step 1: Complete Participant Information

___ Mr.     ___ Ms.

Name: _____________________________________________________

Bus. Phone: ________________________________________________
(include area code)

Extension: ______________________________

Fax: ______________________________________________________
(include area code)

Email: ____________________________________________________

Title: ____________________________________________________

Employer: _________________________________________________

Employer Address:
____________________________________________________________

____________________________________________________________

City:_________________________________________

State: ___________________________ Zip: ______________

I will need Continuing Legal Education credit for (state): ______________

My Bar # is: ___________________________

(CLE credit must be requested at least 45 days in advance of the seminar.)

Step 2: Payment

IAML's Federal I.D. Number: 95-3548502

Total Fees Due: $1,425.00

If you feel you are entitled to a discount, please indicate discount amount and reason: ______________________________________________________________

Payment:
___ Payment in full
___ Deposit check for one-half of the full fees due
___ Purchase order number _________________________
___ Bill my employer
___ Credit card

___ American Express ___ Mastercard ___ Visa

Cardholder Name: __________________________________

Card Number: _____________________________________

Expiration Date: (mm/yy) ____________________________

Signature: ________________________________________

Name as you would like it to appear on certificate:
_______________________________________________________________

Confirmation of registration will be sent via e-mail. Confirmation will not be sent via e-mail. If you do not receive a confirmation letter within three business days, please call IAML to verify that your registration was received.

Registrants are responsible for making their own hotel reservations. IAML has made arrangements for participants to receive a special group rate at the hotels where the seminar will be held. To ensure that you will receive a room at the special group rate, please make your hotel reservations at least four weeks in advance of the seminar and mention that you are participating in an Institute for Applied Management & Law seminar.

A minimum of one half of the total fees due to IAML should accompany your registration, or a Purchase Order Number should be provided. The total fees payable should be received by IAML at least two weeks prior to the seminar. Arrangements such as deferred billing can be made to accommodate special circumstances by contacting us. IAML also accepts American Express, MasterCard and VISA. While registrations may be accepted within the two weeks prior to the beginning of a seminar, we suggest that you call IAML to confirm space availability. Participants will receive a full refund of any fees paid if IAML receives written notification that they will be unable to attend at least two weeks prior to their program's starting date. Otherwise, participants are liable for the entire fee. Registrants requesting a transfer to another program within this two week period will be charged an additional fee of $75.00 per day for each program day transferred. You may substitute an associate at any time.

If you feel you are entitled to a discount, it must be requested on this registration form - discounts will not be given once a registration has been processed.