NATLE 2004

GOVERNMENTAL AFFAIRS CONFERENCE

REGISTRATION

Please read the following instructions carefully before completing this form.

October 22:Registrations must be received by this date to qualify for handout materials, printed name badges, luncheon, and reception tickets.

October 29:Registration must be received with payment to avoid being charged the door registration fee.

Door registrants will not be guaranteed handout materials on site, luncheon seating, or tickets to social events unless space allows.

Please use one formper registrant; photocopy for additional registrations and return by fax with credit card informationto: 850-668-8304, or mail with a check (US Dollars only, please) to the address at the end of this form.

Cancellation Policy:Cancellations received before October 22will receive a full refund. Cancellations after this date will be refunded at 50% of the registration fee paid if received byOctober 29. No refunds will be extended after October 29.

Thank you for…

Printingclearly or attaching your business card, and using onlyone formper registrant.       

 Attorney      NATLE Member/TLA Staff  

Printed Name_________________________________________________________________  

Nickname for Badge ___________________________________________________________

Phone (             ) ___________________________  Fax (              ) ___________________

Email ______________________________________________________________________

Title _______________________________________________________________________

Firm/TLA ____________________________________________________________________

Address_____________________________________________________________________

City____________________________________ St/Pr & Postal Code____________________

Specialaccommodationsor dietary Requirements  ___________________________________

_____________________________________________________________________________

Please attach additional information if necessary; every effort will be made to accommodate your needs.

NATLE Members Only:Are you attending the Business Meeting Luncheon on Tuesday?  Yes   No

ATLA Council of PresidentsMembers Only:Are you attending the luncheon meeting  on Tuesday? 
Yes   No

Registration Fees*

If Payment is received       before October 29       at the Door                       

U.S. Registration Fee................... $315.00.... $350.00

Canadian Fee in US Dollars............ $225.00.... $260.00

*Registration fees include handout materials, continental breakfast each day, morning and afternoon breaks, one luncheon ticket for Monday, and one ticket for the Welcome Reception. Additional luncheon tickets may be purchased for $35 each.

Additional LuncheonTickets for  Monday, November 8

Please reserve #_____ additional tickets at $35 each (1 ticket is included with registration)

enclosed for Additional Luncheon Tickets:  $__________

enclosed for registration: $__________

Grand Total enclosed: $__________

By signing below, I agree to receive confirmation of this registration via fax or email, as well as other notices, advertisements, announcements, brochures, invoices, and other information from the National Association of Trial Lawyer Executives via facsimile, or email.  I further agree that my express permission to fax or email me such notices, invoices and other information will continue and have no date of expiration.

Signature: ____________________________________ Date _____/_____/_____

Payment Options    (All fees payable in US dollars only)      

Check enclosed payable to NATLE ~Or~  Credit Card Payment:           Master Card    Visa   Exp. Date  _____/_____/_____  

Acct. No.________________________________________________________________________

Credit Card address____________________________________________________________

Name on Card___________________________________________________________________Signature________________________________________________________________________

Mail with check to:

NATLE, 1400 Village Square Boulevard, #3-138, Tallahassee FL32312-1250

Return by fax with credit card information to (850) 668-8304

Questions? Call (850) 668-6905