Registration Form

First Name:  
Last Name:  
Firm/Institution:  
Address:  
City:  
State and Zip:  
Email Address:  
Phone Number:   -
     
 
Fee Level
Friday Conference
  BCLT Benefactor ($250) **
  BCLT Members ($350) **
  BCLT Patrons ($400) **
  Corporate ($450) **
  Academic/Non-Profit ($150) **
  Student ($50)
   

** Refunds, less a $50 non-refundable processing fee, will be made for cancellations received by March 18, 2005.

For the purpose of registration, "non-profit" includes academic, government, NGO and other not-for-profit organizations.

The registration fee includes:
• Conference materials
• Continental breakfast and break refreshments
• Catered lunch

  
 
Payment
Credit Card Type:  
Name on credit card:  
Credit Card Number:  
Expiration Date:   /
     

If you wish to pay by money order or check, please print out this form and mail form and payment to the address below. You can also fax in this form with a credit card number.

   Berkeley Center for Law & Technology
   355 Boalt Hall
   Berkeley, CA 94720-7200
   
   fax: 510-643-1328
 
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