|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: (choose as many as you wish, by clicking on each choice while pressing the Ctrl key - scroll to see all choices)*
|The number of courses or seminars chosen is (default is 1, update as required)*:|
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) , Season Pass:, CLE
Bundle (12 credit)
, 12 Session Pass: , MCLE coupons: , Bridge the Gap 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.