Register for Event

Name*

First Last

Firm Name

WSBA Bar Number

Email*

Email Newsletter

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Attendees are:*

Member(s)

Price: $60.00

Number of Members

Please enter the names of each member who will be attending.

Member Type	First Name	Last Name	Company	Email	Bar Number	Meal

Non-Member

Price: $80.00

Number of Non-Members

Please enter the names of each non-member who will be attending.

Member Type	First Name	Last Name	Company	Email	Bar Number	Meal

Students

Price: $35.00

Number of Students

Please enter the names of each student who will be attending.

Member Type	First Name	Last Name	Company	Email	Bar Number	Meal

Payment Method

*A $5.00 fee will be assessed to payments made at the door

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code