Application Form for Intellectual Assets & Technology Law Institute

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Texas Institute of Continuing Legal Education
21st Annual Intellectual Assets & Technology Law Institute
P.O. Box 4646
Austin, Texas 78765-4646
Phone: 512-451-6960
Fax: 512-451-2911
Email: info@infolaw.org

Please register me for the 21st Annual Conference as follows:

Early Bird Registration fee (Due by 5:00 p.m. September 15)............................$695.00
Registration fee (Due by 5:00 p.m. October 3)..........................................$745.00
Door Registration fee .................................................................$795.00

Registration Fee = $
Wednesday Opening Reception Tickets @ $50.00 = $
Friday Luncheon Tickets @ $26.00 = $
Friday Luncheon Tickets @ $26.00 = $

I cannot attend the institute. Please forward the following:
Sets of Audio CDs and written course materials @ $752.34 = $
Sets of Written course materials @ $297.69 = $

TOTAL TO BE CHARGED TO CREDIT CARD = $

No refunds after 5:00 p.m., Friday, September 29, 2006.
Cancellations & General Information: See cancellation policy & general information.

First Name:
Last (Family) Name:
Firm/Organization:
Street Address/P.O. Box:
City:
State/Prov. and Country
Zip or Postal code:

Telephone (with area codes)
Work:	Home:	Fax:

State Bar:
Bar Card Number:

Please Charge to:VisaMaster Card American Express
Card Number:

Card Expiration Date:

Authorized Name Signifying Signature:

Date Signed:

Press the Submit button below to automatically e-mail this application form. If you are not contacted by the Institute within a week or so, please contact it at the above address to ensure that your e-mail application was received.

If you are unable to use this on-line E-mail application form, please contact the Institute by phone, fax or E-Mail and request an application form by mail.