Certificate in Employee Benefits Law Seminar
Registration Form
Step 1: Course Length
I am registering for:
___ Complete Seminar - $2,175.00
Only the block(s) indicated below:
___ Block I - $1,000.00 (2 days)
___ Block II - $500.00 (1 day)
___ Block III - $900.00 (1 1/2 days)
Participants may register in only one or two blocks although participation in all three blocks of the
4½ day seminar is recommended. Participation in the complete seminar is required in order to receive a
Certificate of Completion.
Step 2: Choose A Date
Course Dates for The Certificate in Employee Benefits Law Seminar:
___ Orlando, FL: March 19-23, 2012
___ Scottsdale, AZ: April 16-20, 2012
___ Orlando, FL: July 23-27, 2012
___ Newport Beach, CA: July 30-August 3, 2012
___ Las Vegas, NV: October 22-26, 2012
___ Washington, DC: November 12-16, 2012
Step 3: Complete Participant Information
___ Mr. ___ Ms.
Name: _____________________________________________________
Bus. Phone: ________________________________________________
(include area code)
Extension: ______________________________
Fax: _______________________________________________________
(include area code)
Email: _____________________________________________________
Title: _____________________________________________________
Employer: __________________________________________________
Employer's Address:
____________________________________________________________
____________________________________________________________
City:_________________________________________
State: ___________________________ Zip: ______________
Name as you would like it to appear on certificate (full seminar registrants only):
_______________________________________________________________
If you need a copy of your confirmation and invoice/payment receipt sent to someone else, please provide their
e-mail address here:
_______________________________________________________________
I will need Continuing Legal Education credit for (state): ______________
My Bar # is: ___________________________
(CLE Credit must be requested at least 45 days prior to the seminar.)
Step 4: Payment
IAML's Federal I.D. Number: 95-3548502
Total Fees Due: $____________________________
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
___ American Express ___ Mastercard ___ Visa ___ Discover
Cardholder Name: __________________________________
Card Number: _____________________________________
Credit Card Billing Address (if different from address above):
____________________________________________________________
____________________________________________________________
Expiration Date: (mm/yy) ____________________________
Signature: ________________________________________
Confirmation of registration will be sent via e-mail within THREE business days. If you do not receive confirmation within
three business days, please call IAML to confirm that your registration was received.
Registration fees are: Full 4½ seminar: $2,175.00; Block I only: $1,000.00; Block II only: $500.00; Block III only: $900.00;
Blocks I & II: $1,500.00; Blocks II & III: $1,400.00; Blocks I & III: $1,900.00.
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.
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 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, Discover 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. Participants may substitute an associate
at any time.
