Guest Attendee
2016 Fall Conference October 5 – 7, 2016 The Broadmoor – Colorado Springs, CO
PLAC Guest Attendee Program PROGRAM CRITERIA: In order to be eligible for this program the guest registrant must be a partner or senior associate, and a PLAC member from the firm must also attend the conference. Registration for this program is restricted to one attorney per sponsor. Space is limited and registrations will be honored on a “first come first serve” basis. ___________________________________________________ Name (as it should appear on your name badge)
Enclosed is a check for $_______________ made payable to PLAC
___________________________________________________ Name of PLAC member with whom you are attending
Please charge $_______________ to
___________________________________________________ Firm/Company
Visa American Express
MasterCard
___________________________________________________ Address
Card #: _____________________________________________
___________________________ _______ _______________ City State Zip
Name on Card: ______________________________________
CCV #: ________________ Exp. Date: ________________
Billing Address: ______________________________________ (_____ )___________________ Phone
(______)________________ Fax
___________________________________________________ Email REGISTRATION FEES th
On or before July 29
City:_____________________ State:_______ Zip: __________ Signature:___________________________________________ SEND PAYMENT By Fax: (855) 873-5179 (credit card payments only)
th
After July 29
By Mail: Product Liability Advisory Council Attn: Conference Registration $1,295 $1,400 1850 Centennial Park Drive, Suite 510 Reston, VA 20191-1517 Registration fee includes materials and conference meals. EMERGENCY CONTACT INFORMATION Please provide us with information for the person we should contact in case of an emergency.
CANCELLATION POLICY This registration is non-refundable, but may be transferred to another guest with prior approval from PLAC. Please contact Kim Condon, Director of Membership, at [email protected] or by calling (703) 264-5300.
Name & Relationship
Telephone Number
Office Use Only Authorization Code___________________________ Transaction Code_____________________________ Personal Check________ Company Check________ Batch Number _______________________________
PLAC Guest Attendee Program PROGRAM CRITERIA: In order to be eligible for this program the guest registrant must be a partner or senior associate, and a PLAC member from the firm must also attend the conference. Registration for this program is restricted to one attorney per sponsor. Space is limited and registrations will be honored on a “first come first serve” basis. ___________________________________________________ Name (as it should appear on your name badge)
Enclosed is a check for $_______________ made payable to PLAC
___________________________________________________ Name of PLAC member with whom you are attending
Please charge $_______________ to
___________________________________________________ Firm/Company
Visa American Express
MasterCard
___________________________________________________ Address
Card #: _____________________________________________
___________________________ _______ _______________ City State Zip
Name on Card: ______________________________________
CCV #: ________________ Exp. Date: ________________
Billing Address: ______________________________________ (_____ )___________________ Phone
(______)________________ Fax
___________________________________________________ Email REGISTRATION FEES th
On or before July 29
City:_____________________ State:_______ Zip: __________ Signature:___________________________________________ SEND PAYMENT By Fax: (855) 873-5179 (credit card payments only)
th
After July 29
By Mail: Product Liability Advisory Council Attn: Conference Registration $1,295 $1,400 1850 Centennial Park Drive, Suite 510 Reston, VA 20191-1517 Registration fee includes materials and conference meals. EMERGENCY CONTACT INFORMATION Please provide us with information for the person we should contact in case of an emergency.
CANCELLATION POLICY This registration is non-refundable, but may be transferred to another guest with prior approval from PLAC. Please contact Kim Condon, Director of Membership, at [email protected] or by calling (703) 264-5300.
Name & Relationship
Telephone Number
Office Use Only Authorization Code___________________________ Transaction Code_____________________________ Personal Check________ Company Check________ Batch Number _______________________________
