Registration Form

PBA CIVIL LITIGATION SECTION
PHILADELPHIA REGIONAL DINNER
KEYNOTE SPEAKER: HON. MARJORIE O. RENDELL
RITZ-CARLTON
PHILADELPHIA, PA
Wednesday, September 14, 2011

Credit Card Payment REQUIRED!
Name:
Address:
Supreme Court ID No:
Email:
Phone:

Entree will consist of petit filet and crab cake combination Please contact PBA if you require any special services including any special dietary requirements/substitutions.

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


REGISTRATION FEES - CHECK APPROPRIATE BOX
  PBA Section Member - $50
 
Non-section Member - $70
 

Total Amount Due:
To help prevent spam,
please enter the following 5 letters
CHVBH
then click the submit button.

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 September 2, 2011 to:
Pam Kance
PA Bar Association
P. O. Box 186
Harrisburg, PA 17108
Phone: (800) 932-0311 ext. 2245