The West Virginia Bar Association

Teleseminar Registration Form

Important: All payments must be received BEFORE seminar date!

Fill out form as completely as possible, print and mail with check or money order (no cash please!) to:

The West Virginia Bar Association
P.O. Box 2162
Huntington, WV 25722

Firm Name:
Registrant: (Last Name, First Name MI)
Other Member: (Last Name, First Name MI)
Non-member: (Last Name, First Name MI)
Non-member: (Last Name, First Name MI)
Address :
Address 2:
City:
State:
Zip:
Phone:
Fax:
E-mail:
*Attach additional sheet of paper if more space is needed.*
Total Members:
Total Non-members:
Total Amount Enclosed:	$

Which Teleseminars are you registering for? Attach additional sheet if more space is needed.
Date	Seminar Title

To register with credit card, call: (Have names of all members and non-members ready if applicable.)

(800) 944-9822, or
(304) 522-2652

Seminar Cost:

Members	$69.00
Additional members (same location)	$49.00
Non-members	$89.00
Additional Persons (same location)	$69.00

©2005 West Virginia Bar Association
P.O. Box 2162, Huntington, WV 25722 Phone: (800) 944-9822, (304) 522-2652, Fax: (304) 522-2795