Suffolk Academy of Law Registration Form

To be used for on line registration of Academy Programs

Suffolk Academy of Law requests that you complete the following form so that we may register you for programs you have selected. Please note that the information contained herein is transmitted to us through a secure site. If you have any questions you may contact us:
(631) 234-5588, or E-Mail us at

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 choice above  *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