Registration Form

Registration Form

Pennsylvania Bar Association
Civil Litigation Section
Philadelphia Regional Luncheon
Keynote Speaker: Honorable Pamela Dembe
Table 31
Philadelphia, PA
Wednesday, July 21, 2010
Credit Card Payment REQUIRED!
VISA and MASTERCARD Only

Name:

Address:

Supreme Court ID No:

Email:

Phone:

Describe any special service or if you have any dietary requirements.

REGISTRATION FEES - CHECK APPROPRIATE BOX

PBA Section Member - $45

Non-section Member - $55

Total Amount Due:

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To complete the registration process you will need to "Proceed to checkout" in the store and walk through the steps to process your credit card information. For assistance contact Traci Raho at (717) 238-6715, ext. 2255.

Return this form NO LATER THAN July 14, 2010 to:
(No refunds issued after this date) Pam Kance
PA Bar Association
P. O. Box 186
Harrisburg, PA 17108
Phone: (800) 932-0311 ext. 2245