Certificate in Environmental, Health & Safety Law Seminar
Registration Form



Step 1: Course Length

I am registering for:
___ Complete Seminar - $1,925.00

Only the block(s) indicated below:
___ Block I - $1,000.00 (2 days)
___ Block II - $1,425.00 (2½ days)

Participants may register in only one block, although participation in the full 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 Certificate in Environmental, Health & Safety Law Seminar:

___ Las Vegas, NV: September 15-19, 2008

___ Newport Beach, CA: March 9-13, 2009

___ Orlando, FL: March 16-20, 2009

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):
_______________________________________________________________

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
___ Credit card

___ American Express ___ Mastercard ___ Visa

Cardholder Name: __________________________________

Card Number: _____________________________________

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

____________________________________________________________

Expiration Date: (mm/yy) ____________________________

Signature: ________________________________________

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

My Bar # is: ___________________________

(CLE Credit must be requested at least 45 days in advance.)



Confirmation of registration will be sent via e-mail. If you do not receive confirmation within three business days, please call IAML to confirm 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 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. 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.

Registration fees are: Full 4½ seminar: $1,925.00; Block I only: $1,000.00; Block II only: $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.