Advanced Certificte in Employee Benefits Law Seminar

Registration Form

Step 1: Choose A Date


Step 2: Complete Participant Information

Mr. Ms.

Name:

Business Phone: (include area code)

Extension:

Fax: (include area code)

Email:

Title:

Employer:

Employer Address:

City:

State:

Zip:

Name as you would like it to appear on certificate:

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

    My Bar Number is:
   
(CLE credit must be requested at least 45 days prior to the seminar.)

Total Fees Due:

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

Payment:
Bill my employer

    Purchase Order Number
Credit card

Cardholder Name:

Card Number:

Credit Card Security Code:
(3 digit code on back of Visa/Mastercard or 4 digit code on front of American Express)

Credit Card Billing Address: (if different from address above)


Expiration Date: (mm/yy)


Confirmation of registration will be sent via e-mail. If you do not receive a confirmation e-mail 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 seminars are held. To ensure that you will receive a room at the special group rate, please make your hotel reservation at least four weeks in advance of the seminar and mention that you are participating in an Institute for Applied Management & Law (IAML) 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. If paying by credit card, your payment receipt will be mailed to the address you provided on the registration form, unless you make other arrangements. 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.

The registration fee for this seminar is $1,425.00. 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.