|Date of Request *: || Please use mm/dd/yy format|
|Name (full name [first & last name])*:|
|E-mail Address*: |
|Address where we can contact you *: ||Street address:|
City: State: Zip:
|Daytime Phone (include area code)*: |
|Evening Phone (include area code): |
|Cell Phone (include area code): |
|Fax (include area code): |
|I wish to be notified of future seminars by e-mail. ||Yes No|
|My membership status is: * ||SCBA Attorney member, SCBA Student member , Non-Member Attorney |
|Program(s) you wish to register for: *
|The number of courses or seminars chosen is (default is 1, update as required)*:|
As a benefit of
your SCBA membership, all members in good standing may claim two
free CLE credits to an Academy live programs* during the year June 1,
2016 – May 31, 2017. To use this credit, check the appropriate program
*certain restrictions apply
Electronic registration saves you money! Deduct $5.00 off the price of each course you have registered for.
The total amount due is (If total payment is by pass or coupon, or if the program is FREE enter 0.00)*:
|Method of payment:|
Payment accepted by credit card or where permitted by Pass or Coupon. Please choose the appropriate plan.
Payment option information:
Please apply to my*:
Credit Card (fill out below) , CLE
Bundle (12 credit)
, 12 Session Pass: , SAL Pass
|How to Submit this form:|
You may submit this form by clicking on the "submit" button below.
You may not mail or fax this form!
The Suffolk County Bar Association and the Suffolk Academy of Law are not responsible for typographical errors.
For other questions or information you may call the Suffolk Academy of Law at (631) 234-5588 or you may e-mail your questions to firstname.lastname@example.org.